Abortion

Every year in the United States Abortion is one of the most common medical procedures performed. Nearly 40% of women will end up with pregnancy by abortion in their reproductive lives.

Women of every class and creed end up with abortion due to certain problems where as the typical women ends up her pregnancy is young, white, unmarried, and poor.

Abortion is also termed as elective termination of pregnancy which is so common in US as well as all over the world.

•    In the year1973, The US Supreme Court legalized termination of baby in the famous Roe v Wade decision and at present there are approximately 1.4 million abortions which are done every year in US.
•    Every year 20-30 million legal abortions are performed all over the world and 10-20 million illegal abortions are done. The abortions which are illegal are not safe and the account for 13% of al deaths of women due to serious complications. Death due to abortion is totally unknown in US/in any country where abortion is available legally.

Despite of Induction of more new and effective and widely available birth control methods, every year the occurrence of pregnancy is more than half of 6 million pregnancies in US are considered by the unplanned by the pregnant women.

Making Abortion Legal

Hundreds of federal and state laws have been passed since 1973 the US Supreme court decision which made the abortion legal. In the field of medicine abortion is legally active area and the visible one. These laws cover a range of controversial queries like the following:

•    Whether parents/spouses should be notified before the abortion of women?
•    Before termination has there been any progress so that fetus can live without any support?
•     Before abortion should there be any compulsory waiting periods?
•    What might be mandatory wording for counseling sessions?
•    For abortion should any public funds to be used?
•    What are the rules which are to be applied to abortion providers?
•    What are the provisions to be made against particular abortion techniques methods?
•    Emergency contraception should be permitted/not? 
•    In case of sexual assault and rape should the rules be different?

Before abortion was legal

Most of the US states had no particular abortion laws before the 19th century. Through the assistance of certain medical personnel women were able to end up the pregnancy.

•    Starting with the Connecticut statute and followed by an 1829 New York law, the next consecutive years saw the enactment of many laws restricting abortion, penalizing providers, and in certain cases penalizing the women seeking the abortion.
•    The first US federal law on the subject was the Comstock Law of 1873 which allowed a special agent of the postal service to open mail dealing with the termination of baby in order to suppress the circulation of crude materials.
•    Abortion was forbidden by law from 1900-1960s. On the other hand Kinsey report notified that premarital pregnancies were electively terminated and public and physician opinion started to be shaped by the alarming reports of augmented numbers of unsafe unlawful abortions.

Due to illegal abortions 265 deaths took place in the year 1965. In New York and California, among all the complications which are associated with pregnancy, 20% were because of abortions. There was increase in the rights of women by a range of decisions which are granted by US Supreme Court. No other decision was so important than the Griswold v Connecticut, which in 1965 ruled that a married couple had a constitutional right to get birth control from their doctor.

The Supreme Court case of Roe v Wade was the result of the work of a wide group of people who worked to revoke the abortion laws. In order to formalize their targets abortion rights supporters held a conference in the year 1969 and formed National Association for the Repeal of Abortion Laws (NARAL).

•    Lawyers Linda Coffee and Sarah Weddington met the Texas waitress, Norma McCorvey, who wanted to abort and it was barred by law. She would become the claimant “Jane Roe.” Her case was successfully argued before the US Supreme Courts decision to grant the right to undergo abortion though the ruling came late for McCorvey’s abortion.
•    The court ruled that a woman had full rights to undergo abortion during the first two trimesters (6 months) of pregnancy and this was in the year 1973 in Roe v Wade which was written in opinion of US Supreme Court justice Harry Blackmun.
•    The states have got back more control from the time of this ruling and also strict restrictions were been placed on the abortion services. Federal and state lawmakers continue the debate. The first federal ban was approved by the US senate on a particular abortion method in the year October 2003 and this particular bill was signed by President George W. Bush.

Determining life

When is the life starting? And regarding abortion this has become one of the issue all around the controversy. Following are legal issues:

•    When viability is generally defined it’s referred to the ability/capacity of fetus to live outside the womb of the mother without any life support. With this query a range of landmark US Supreme court dealt with. The court sustained the state of Missouri’s need for pro-abortion viability testing after 20 weeks’ gestation in the In Webster v Reproductive Health Services (1989). Before 28 weeks there are no dependable/medically acceptable tests for this.
•    Preface of this law mentions that life starts at conception, and unborn are at liberty to the same constitutional rights. In a ruling controversy for its enclosure of compulsory waiting periods, elaborate consent processes, and record-keeping regulations, Planned Parenthood v Casey tried to address the issue of feasibility by inserting language identifying that some fetuses never get feasibility and all this was by the year 1992. The court inverted a Pennsylvania law in Colautti v Franklin which was in need of providers to follow particular instructions in certain medical cases and identified the judgment of the doctor in these matters. 

Parental consent

A range of state and federal decisions tried so much to get notification of parents, waiting periods, informed consent, and lastly abortion counseling.
The opponents of abortion feel that parents ought to be known regarding this and agree for their daughter’s abortion who is younger than 18 years and the people who are not against the rights of women say that there is no need of any parent’s consent nor do parents give any approval for termination of pregnancy for women seeking birth control like pills or an intrauterine device (IUD). And they don’t even ask for the consent of parents for a sexually transmitted disease.

Studies show that in case of abortion many women who very younger than 18 years do entail their parents in decision-making. Laws which need parental approval are pushing the minors to get aborted later in their pregnancies. Some of the minors got to travel long distances without any such law.

Intact dilation and extraction

The word Partial-birth abortion referring to partially vaginally giving out a fetus which is alive prior to killing the fetus and finishing the delivery. This meaning widely comprises of all process of second-trimester abortion.

Providers

Doctors who do abortion are in fact specialists in women’s health like obstetricians and gynecologists. Further many researches state that there is no danger in permitting other doctors and nurses to do these methods.

Following are different factors which influenced the number of medical professionals available and trained/educated to do terminations of pregnancy:
•    In this process no medical student will be given any sort of training in this process. Few may be opted to be educated in the procedure and pharmacists can also decide not to give out medicines of medical terminations.
•    Decline in hospitals that are offering abortions services and increase in violence against providers.
•    A drug for medical abortions by name Mifeprex was approved by US Food and Drug Administration (FDA). To do surgical abortion doctors are lacking and this resulted to popular belief that individuals who’re not willing/not skilled enough to do surgical abortion will be forward to give medicines for medical abortion.
•    A range of medical, social, ethical, and philosophical issues affect the accessibility of and limitations on abortion services in US.

Abortion statistics

In the United States:

In accordance to the Centers for Disease Control and prevention, for every 1,000 women roughly about 20 women were of 15-44 years old who under went abortion and for every 1,000 live births approximately 325 abortions were done. In the early 20 years huge development has been made in the technology which is been used for second-trimester abortion. This and further social issues which is related to the abortion have resulted to more women undergoing abortions later in pregnancy.

•    Safety: Getting aborted legally is very safe and infection rates are less than 1% and fewer than 1 in 100,000 deaths happens from the first-trimester abortions. Termination of pregnancy is safer to mother than taking a pregnancy to term.
•    Race: The percentage of women in white is 59.1%, 2% were black and 5.87% were of other creed.
•    Age: Rates of abortion is more between 20-24 year old women. It less amid women who are younger than 20/older than 40 years but in case these women are pregnant they’re probably to have an abortion.

In the world: Among pregnant women 13% of deaths are caused by abortion. New studies revealed that every year in developing countries 50 million abortions are done where amid these 20 million abortions were unsafely done  due to lack of doctor’s training /conditions.

Surgical

After conception of 1-2weeks Home pregnancy tests obtainable at a drug store can indicate pregnancy. Abortions which have been done at the earlier stage at times been named as menstrual extractions.

•    Abortions are done surgically/medically incase they are done before 9 weeks from the menstrual period.
•    Termination of pregnancy is done by dilatation and suction curettage method from 9 weeks until 4weeks.
•    Through dilatation and evacuation method surgical abortions are done after 14 weeks.
•    Through labor induction, prostaglandin labor induction, saline infusion, hysterectomy, dilatation and extraction, or intact dilatation and extraction, abortion can be done after 20 weeks of gestation

The terminations are mostly done in the out-patient office setting beneath the local anesthesia with/without sedation.

Medical

The term applied to an abortion is medical abortion which is brought by medication taken to induce it. This can be achieved by a variety of medicines provided either as single tablet/a series of tablets. The percentage of its successfulness is 75-95% where jus 2-4% failed which needed surgical abortion. And 5-10% was of incomplete abortions relying on the gestation stage and the medications used.

When medical termination of pregnancy is chosen by women they get great amount of satisfaction and it also makes them to choose the same method again incase of any abortion in future. In order to know the best procedure, suitable medications further studies have to be done.

Certain amount of safety can be given by medical abortions where they eradicate the amount of danger of injury to a woman’s cervix/uterus from surgical instruments. In certain cases some women require surgical abortion and for safety side women undergoing medical abortions need access to providers willing to perform a surgical abortion should it be necessary

Mifepristone which is also known as RU-486 was approved by the FDA in the year 2000 of the September month. This is used in a particular specific medical plan that comprises giving another drug, misoprostol only for those who don’t terminate with mifepristone alone. The drugs approved for other conditions are Methotrexate and misoprostol and it can be used for termination of pregnancy. Further study will help out to know which drug/combination is perfect for termination.

Bleeding is involved in the method of abortion which is frequently like a heavy menstrual period and ought to be distinguished from hemorrhage which is again a serious problem. The woman ought to consult a doctor in order to ensure that the procedure is finished.

 

History

After taking brief and targeted medical history by your doctor then abortions will be done. You’ll be questioned whether any treatment/care taken in the current pregnancy and also about previous pregnancies. You’ll also be questioned about any diseases like sexually transmitted infections.

You’ll be asked for the history of diabetes, high blood pressure, heart disease, anemia, bleeding disorders, or surgery by your doctor. You got to stay calm and stable prior to termination in case you have any active medical problems/have method done in the facility which has the capacity to handle all the special medical problems.

•    Incase there any problems which are very familiar like severe brain abnormalities that will not permit survival of fetus, and incase these problems are known through any diagnostic testing then woman can opt to end up the pregnancy.

•    Counseling comprises of most familiar and usual problems with fetus like development of major system failures and problems which cannot be repaired dealing with the heart, nervous system, spine, brain, abdomen, kidneys and breathing ad digestive systems. 

Physical

A summary of physical examination is done prior to an abortion. Its main attention is when the pregnancy started and whether you’re in position to undergo the process and also to test for any sexual transmitted disease.
 
Lab tests

In order to confirm your pregnancy, pregnancy tests are used. In certain cases home tests are accepted by most of the providers. For sexually transmitted diseases and for hepatitis blood test will be taken. In case you’ve any urine tract infection then urine test will also be taken.
Imaging studies 

In the first trimester an ultra sound may not be always done. How many fetus/fetuses are developed, its size, a image of uterus and ovaries & to rule out a problem like an ectopic pregnancy (which is a life-threatening state where the fetus develops out of the fetus) are keenly examined by the doctor.
Medications

To be on the safer side against any infections you may be given antibiotics by your doctor. Antibiotics are normally given on the day of the process and for the next day/two.
 

Decision-making process is a very vital thing which is given great attention by the counseling like the choices for continuing pregnancy, medical issues of pregnancy, data about pregnancy itself, full revelation of danger of continuing the pregnancy to deliver a baby, information and choices for abortion process and lastly about birth control decision. Medical and surgical abortions, its benefits are frequently reviewed.

•    The process of counseling comprises of people chosen by her but mainly targeted on the woman herself. Only a skimpy research has been done on male involvement in the counseling and those studies states that men are involved more than 40% of decisions. Some women take long time while some reach the decision swiftly. Incase you require any long support then the counseling may give you some referrals.
•    To take any sort of decision you’re not supposed to feel pressured and spend some time to consider various options of yours.
•     You may be asked few queries in counseling which are designed to encourage meaningful forum of issues as they be relevant to you. Counseling takes longer as you’ll have many emotions.

There are certain state laws that apply to the counseling method. There are compulsory waiting times in some states among the information session and actual session. Where as other few states ask for the notification of parents and some states see to that the subjects are covered completely.

Once you’ve got the confirmation of pregnancy and your health care provider very well knows how many weeks along the pregnancy is and you’re to terminate then the method provided typically reflects your stage of gestation. Medical/surgically early abortions can be done successfully.  Most of the facilities don’t have the established protocols/personnel with technical ability to provide medical abortions.  And hence abortions are done surgically.

Preoperative care

•    In order to undergo abortion women travel afar and finishing the preoperative preparation make them feel comfortable in a short office visit. Waiting periods are needed in some states by the law in such case it can be done in stages.
•    A targeted history, physical examination, laboratory work, and ultrasound is involved by the assessment process which is followed by a counseling session.
•    Preparation of second-trimester is quite tough. It’s not possible to prepare the cervix before 24 hours but the fundamental assessment method is alike.
•    In order to examine for apparent problems with fetus ultrasound examinations can be used.
•    Intra-amniotic injection of the drug digoxin is provided by certain center which ends up the heart activity in fetus prior to a second trimester abortion.
Medical abortion
•    First- and second-trimester medical abortion

o    Through Misoprostol alone, methotrexate-Misoprostol combination regimens or Mifeprex (RU-486) with/without Misoprostol first-trimester i.e. first three months of pregnancy terminations is achieved. In other countries other prostaglandins are used.
o    Medical abortion is indicated for those people who consent to a medical abortion but also ready for surgical abortion in case the abortion fails. Less than 42-49 days is the gestational stage but a lot of protocols may be used which also comprises 62days from menstrual period.

o    The Mifeprex/Misoprostol drugs are given as follows:

•     On the first day Mifeprex is taken as a pill (600 mg) at the doctor’s office.
•     On the third day Misoprostol is taken as pill/inserted vaginally at home and should be at observation for four hours.
•     In order to know whether abortion has been completed you got return to the office between days of 12 and 20.
•     You can go for surgical abortion or can give a repetitive dose of Misoprostol.

o    The methotrexate/Misoprostol regimen is alike, as follows:

•     On day 1 Methotrexate is injected.
•     At home Misoprostol is taken vaginally on 6-7 day and on day 8 go to office in order to find if abortion has taken place/not. By monitoring Misoprostol can be done again/surgical abortion can be finished.

•    Prostaglandin-induced second-trimester abortion- Vaginally, orally/injected into fetus medicine can be induced.
•    Saline-induced abortion: The method which consumes long time and this method was followed 20 years ago which is not performed frequently though it’s safe.

Surgical abortion

•    Cervical dilatation and preparation

o    For the first trimester termination especially the period between less than
10 weeks gestation, you do not need to have the cervix dilated. You might’ve a small sterilized stick known as laminaria japonica in case you’re in the latter part of first trimester which is been placed in your cervix. This may be placed all over the night and its useful for four hours.
o    A sterilizing solution through Betadine cervix is prepared before inserting a stick. An injection of anesthetizing can be given into the cervix and it’s the start in the method of abortion. Prior to begin the dilatation process its important to note that you understand all the risks and all those must’ve elucidated in the counseling.

•    Sedation during abortion

o    As each step is explained by the doctor most of the women get coached through an abortion. Numbing is preferred by some women in their cervix and most don’t need any IV sedation.
o    IV fluids will be used incase huge sedation is opted.

•    First-trimester surgical abortion

o    Through cervical dilatation early abortions are done and using a hand held syringe/small bore cannula, a tube which is attached to a suction machine. A manual aspiration means abortions done with syringe. Vacuum aspirator produces those which are done with suction and these are referred to as a vacuum aspiration. Both the methods consume less amount of time.
o    In order to grab the cervix tools are used after preparation with Betadine and probably insensate. Through the cervix the cannula is inserted into your uterus. By applying suction to the syringe/via the machine the actual discharge is done and in order to complete this method consumes few minutes. There will be loss of small amount of blood.
o    In order to make sure that all has been emptied, your health care provider will check the tissue.

•    Dilatation and curettage (D&C)

o    This is a treatment of incomplete abortion/ particularly it’s a term i.e. normally applied to diagnostic method.
o    Though uterus is emptied with a sharp metal curette, this method is achieved with same kind of dilatation method. Than the flexible/rigid plastic devices, curettes are more dangerous which being used in suction methods and they’re not suggested for abortion procedures.

•    Second-trimester dilatation and evacuation

o    The safest method which is very usual method of second-trimester termination is dilatation and evacuation which is used by experienced doctors. This dilation consumes more number of hours and probably even days through sticks in order to enlarge the cervix.
o    The procedure is achieved once the cervix becomes widen by using a combination of suction curettage and manual discharge of fetus and placenta. In order to guide the tools ultra sound can be used.
o    Than the first-trimester method, the method is more not comfortable and is of long duration. With local anesthesia most of the women can undergo it without any trouble.

•    Dilatation and extraction

o    By cervical preparation this method is achieved which is alike to the cases of dilatation and evacuation but the fetus is taken out in an intact condition. After the contents are discharged the fetal head is collapsed so that it passes through the cervix.
o    This method is done by only some providers and for cases of maternal medical complications/serious medical problems with fetus it’s normally reserved.
o    Intact dilatation and extraction is similar to the procedure and by abortion opponents it has also been called as partial-birth abortion.

•    Induction of labor

o    Standard drugs used to bring labor for birth are experienced with most of the doctors and in the second trimester of pregnancy these can be used.
o    For this method premature rupture of membranes is one indication.
 

•    Activity: After an abortion you might be recommended for ongoing counseling and support. You can follow your regular diet and start all your usual activities. For few days avoid lifting heavy objects and heavy activities. And also don’t use any tampons, douche or have sexual intercourse for a week.
•    Medications: Though it’s not necessary you may be given medication for pain. You’ll b given medications by your doctor for painful contractions and cramping of your uterus but none is required with a first-trimester method. Incase your suffering from any pain your health care provider may recommend you to have acetaminophen like Tylenol or ibuprofen such as Advil and similar pain killers.
 

Normally a person who has undergone abortion need not stay at hospital unless you’ve got any medical complications with surgical procedure/you’ve got any medical condition where you’ve got to be monitored.

•    Medical care after a surgical abortion

o    You’ll be keenly watched by your doctor for 30 minutes after the surgery in order to check for any abdominal pain and unusual bleeding.
o    IUD for birth control will be inserted incase you’ve decided to use it. You may get an injection on that if you’ve decided to use a hormonal injection form of birth control.
o    In order to ensure the termination of pregnancy and to also check for further medical complications, within 1-3 weeks you’ll be asked to return to your health care provider.
o    Incase you’ve the following symptoms rush to your health care provider:

•     Having pain which turns to be worse
•     When temperature is of 100.4°F/more
•     In 24 hours bleeding flows more than 12 pads and 4-5 pads in an hour.

o    Acetaminophen (Tylenol) which is a pain reliever will be given to you during the first 24 hours after the surgery. You can switch to pain relievers like ibuprofen (Advil) or naproxen after that time.
o    Make sure that you’ve got all the emergency care contact numbers and all the directives in case you’re not able to reach your doctor. If at all you may undergo little amount of bleeding. When too much of clotting/cramping happens there’ll not be much bleeding until fifth day of the surgery.
o    Until bleeding stops/until you’re cleared off by your health care provider at your appointment after the surgery you must not to use any tampons for 5 days and also you shouldn’t have any intercourse.

•    Psychological effects of abortion

o    After undergoing the abortion you have the feeling of sadness, depression and all such normal emotions. After an abortion the most common feeling you get is confidence in decision-making and a sigh of relief. There’re few women who feel guilty and go into deep grief and normally these feelings stay for just few weeks and these don’t result to any of mental issues. There was one such study which showed that women who had undergone abortion had mental health problems like depression 1% of the time compared with 10% of women who gave birth who felt depressed.
o    At the time of decision making, your relationships, religion, age, social support, and whether you’ve mental health issues, your feelings may be affected by your emotional status. Incase your victim of rape/incest you may have quite different feelings and emotions at the time of abortion.
o    In order to work through your emotions and cope up with your feelings counseling is the best option which will very well help you out.

The argument of ethics of abortion has kept abortion at courts and media as the landmark decision in Roe v Wade. It was quite straight forward, lawfully confirming a woman’s right to a private medical decision when preferring a medical method.

As the debate grew furious and the medical issues have become more intricate, rulings in the courts and in the legislatures have expanded beyond this simplistic query to restrictions on gestational age, viability findings, spousal and parental consents, mandatory waiting periods, compulsory language in consents, enforcement of provider qualifications, the access to use fetal tissue for research or medical treatments, the rights of providers and patients to be shielded from overt protest, and, lastly, on access to birth control.

Huge laws and rulings were proposed in a typical year where few particularly criminalize doing abortions. The laws which are currently laid down are quite tough to follow but its briefed out in the State Policies in Brief section on The Alan Guttmacher Institute Web site.

Approximately 9 of 10 out of wedlock pregnancies were electively aborted in the earlier days of 1960s. In a range of medical and nonmedical settings the procedures were done. Nearly20% of all pregnancy associated complications were because of unlawful abortions.

•    Roe v Wade

o    In the year 1965 US Supreme Court constitutionally establishing a woman’s right to privacy was Griswold v Connecticut was the vital decision which was made earlier.
o    Earlier days of 1970s political support was tremendously was in support of legalized abortion and activists for abortion rights particularly sought a plaintiff so that a lawful challenge to abortions might be debated at the court. The decision is named for the plaintiff Norma McCorvey, was the Jane Roe. Induced abortion is defined by the Centers for Disease Control and Prevention as a method planned to terminate a suspected or known intrauterine pregnancy and to produce a nonviable fetus at gestational stage.

•    Late-term abortions

o    A huge political support exists for abortion forbids on late-term abortions/abortions done in third trimester of pregnancy and just 2% of people stand against. Advanced surgical techniques have permitted for surgical abortions to be performed later in pregnancy. People who are against abortion have lobbied against particular methods done late in pregnancy and they have the stance that other methods are preferable.
o    28 states had passed bans on this process in the year 1998, referred to partial birth abortion which is the medical method to known as intact dilatation and extraction.
o    Bush signed a partial birth abortion ban in the month of November 2003 and in accordance to the order of the court, this act currently is not in effect.

•    Parental consent

o    Most of the young women have involvement of their family/parents in decision making to have an abortion. But adolescents who are quite older and living separately don’t have any involvement of their parents. Lot of teenagers takes parental involvement despite of abundant scientific evidence. Teens who don’t get any sort of parental involvement might be at danger either physically/emotionally. A barrage of legislation made a mandatory statement that all minors ought to seek consent of parents/atleast parents ought to be notified in advance of a minor child undergoing abortion.
o    The US Supreme Court backed the laws that have facilitated this to arise legally. 38 states had such laws and 29 states enforced those laws by the year 1999. At present laws that assert the rights of a minor to get her own abortion are followed only in Connecticut, Maine, and the District of Columbia. In order to know the summary of laws view Minors' Right to Consent to Health Care and to Make Other Important Decisions. Accordingly providers of abortion don’t necessitate any permission of parents for minors who’ve started to see adolescents who got to travel for long in order to seek abortion.
o    Variety of groups comprising the consumer’s Bill of rights developed patient right bills and Presidential task force developed the responsibilities. Patients have a right to admittance knowledge and that providers have a right to converse care they think is medically appropriate regardless of the source of that care are particularly stated in these bills.

•    Mandatory waiting periods

o    Compulsory waiting menses command by law that women getting aborted ought to get particular data regarding the pregnancy and pregnancy alternatives.

o    Despite of the fact that these laws typically just command a short 24-hour waiting menses, they’ve the effect of augmenting the percentage of second-trimester abortions in states with these laws.

•    Special concerns

o    It is important to note that the advances in the neo-natal medicine have
lead to the improvement in the survival of the new born babies that have
been born in the premature stage, all these issued have lighted up the
abortion debate in the past twenty days and this has overshadowed the
continued cultural debate on the fact as to when the life begins.
o    The growth in using fetal tissue, fetal stem cells, or even discarded embryos for research and medical treatments continues these days.  In the treatment of diabetes, Parkinson disease, kidney disease, and cartilage diseases, amid others these probable therapies may be pointed out.
o    Most of the fetal tissue researches have been banned by the current national regulations but the National Institute of Health revealed late in 2000 that it’ll let stem cell research. President Bush passed a law in the year 2002 June restricting stem cell research to only preexisting cell lines and embryos left over from in vitro fertilization methods.
o    A premium on male children is placed by a lot of world cultural and reports of choosy abortion of female fetuses have continued to the surface.

•    Provider issues

o    Obstetricians and gynecologists are most of the abortion providers. Anyways providers from range of background may be trained to do abortions safely like family practitioners, and nurses. Physicians are normally receptive to the notion of legal abortions which are available in US. Most receptive tend to be non-catholic and this was shown by the researches and get trained in a residency program where abortion observation was of need.
o    The aims of abortion providers are to keep abortion safe and secure, legal and rare.
o    Woman are travelling farther to undergo abortion, seeking abortion later in pregnancy as providers reduced in number. In case they’re poor and live in most rural regions they’re not able to get services.
o    Posttraumatic stress has been reported in abortion workers exposed to violent abortion protests at their clinics.