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Hartman EE, Parker RA. A 26-Year-Old Woman Seeking an Abortion, 1 Year Later. JAMA. 2000;283(20):2700. doi:10.1001/jama.283.20.2700
From the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, LY318, Boston, MA 02215.
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.
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
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.
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