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1.
Grimes DA. A 26-year-old woman seeking an abortion.  JAMA.1999;282:1169-1175.Google Scholar
2.
Kaiser Family Foundation.  From the Patient's Perspective: Quality of Abortion CareMenlo Park, Calif: Henry J Kaiser Family Foundation; 1999.
Clinical Crossroads Update
May 24/31, 2000

A 26-Year-Old Woman Seeking an Abortion, 1 Year Later

Author Affiliations

From the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, LY318, Boston, MA 02215.

JAMA. 2000;283(20):2700. doi:10.1001/jama.283.20.2700

At Obstetrics and Gynecology Grand Rounds in June 1999, David A. Grimes, MD, discussed a 26-year-old student who had discovered she was pregnant.1 The patient, Ms B, citing cultural and family prohibitions to having a child while unmarried, along with financial barriers, asked to have the pregnancy terminated. Ms B was referred to a family planning clinic, where, after extensive counseling, she chose to have a surgical abortion.

Dr Grimes explained that abortion is a common experience for women throughout the world. He discussed barriers associated with abortions, such as cost, gestational age limits, access to abortion providers, legislative issues, and harassment. Dr Grimes described the demographics of unintended pregnancies in the United States and characteristics of patients choosing to have abortions. He presented evidence that psychological sequelae following abortion tend to be minor and that most women feel relieved, as Ms B did. Dr Grimes also detailed methods of medical abortion and innovations in this field. He recommended that Ms B follow up with her physician to ensure that her pregnancy had ended and also mentioned that Ms B could have opted for medical abortion. Dr Grimes reported that abortion in the United States is safe and emphasized data that patients are highly satisfied with the quality of care they receive.2

We could not reach Ms B, but we asked her physician, a house officer, to comment on the year that has passed.

Dr k, the primary physician

Shortly after her abortion, Ms B wanted to change her method of birth control from periodic abstinence to a more effective method. I prescribed oral contraceptives (a desogestrel and ethinyl estradiol combination) for her after her follow-up pregnancy test was negative. I am not sure how consistent she was in taking the pills. At a visit in March, when I was on another rotation, Ms B saw a senior physician and requested a pregnancy test, which was negative. She had not been taking her oral contraceptives for 1 month because of stress and breaking up with her boyfriend of many years. Although she was supposed to follow up with me, she did not make the appointment.

This week, Ms B came in requesting another pregnancy test. Her last menstrual period was supposed to be 2 weeks ago. She and her ex-boyfriend saw each other 3 weeks ago and had unprotected sexual intercourse. Ms B had not taken oral contraceptives for more than 2 months.

Ms B did not appear surprised when her pregnancy test result came back positive. We discussed her options, but she said abortion was the only option she wanted. We also talked about future contraception choices, and she was interested in depot-medroxyprogesterone acetate injection, as she does not feel she will be compliant enough with oral contraceptives. I also explained the option of emergency contraception if she has unprotected sexual intercourse again.

Ms B went to the gynecology clinic to plan the abortion. This time she will likely choose a medical abortion, because she is very early in the pregnancy.

References
1.
Grimes DA. A 26-year-old woman seeking an abortion.  JAMA.1999;282:1169-1175.Google Scholar
2.
Kaiser Family Foundation.  From the Patient's Perspective: Quality of Abortion CareMenlo Park, Calif: Henry J Kaiser Family Foundation; 1999.
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