Dear Doc | I was on the pill and got pregnant. Help!

Q Dear doc, I am a worried young female. I became pregnant at 13 and had a bouncing baby girl. I am now 20 and pregnant again. I was on the pill so I really didn't expect that. I am 13 weeks pregnant. Is it too late for an abortion to be done? I am in school and I cannot afford a next baby. Please help me ASAP.

A Your question is a very controversial one to which there is no simple straightforward answer. Unfortunately many women find themselves in a similar situation as you have.

To answer your question simply, the answer is no, it is not too late for an abortion; but please allow me to also give you some very important information regarding this.

Firstly and most importantly, abortion in Jamaica is illegal! Any person who attempts to bring about a miscarriage, or performs a task to obtain one, is subject to life imprisonment, with or without hard labour.

However, the law will allow for an abortion to be performed to save the life of the pregnant woman.

Grounds on which an abortion is permitted includes:

- To save the life of the woman

- To preserve the physical health of the woman

- To preserve the mental health of the woman

The law does not make allowances for abortions in the case of Rape or incest, Fetal impairment or for economic or social reasons.

Due to these facts, physicians in Jamaica are usually hesitant to perform an abortion, as the law affords them no real protection, and many of them fear the possibility of prosecution.

The other important bit of information, is how it would be performed, and this largely depends on how far along you are in the pregnancy. For countries where abortion is legal, for most of them it is allowed up to "viability" or 24 weeks.

There are two basic ways abortions are performed:

- A 'medical abortion' which is when you take medicine to end the pregnancy.

- The other is called a 'surgical abortion' or 'Dilation and evacuation (D&E)', which is when a healthcare provider does a procedure to remove the pregnancy.

A medical abortion is most effective for pregnancies that are less than 10 weeks. If the pregnancy is later (beyond 14 weeks), you may be given medicines that induce labor to cause an abortion. This type of abortion would be performed in a hospital and is usually called "labor induction." This later procedure however is not as common as a surgical abortion for that gestational age.

A surgical abortion is done in a clinic or hospital to end a pregnancy. It can be done for early as well as later pregnancies. The procedure is done by removing the pregnancy tissue through the cervix, by aspirating the amniotic fluid and removing the fetus with forceps through the cervix and vaginal canal. Usually disarticulation (or dismemberment) occurs as the physician delivers the fetal part grasped in the instrument and pulls it through the cervix. A final suction curettage is often performed to ensure that the uterus is completely evacuated.

At your gestational age, the latter option is most often done.

I do suggest you seek support and discuss alternate options with your health care provider along with a trusted relative or friend.

Q Dear Doc, I was 38 years old on October 23. I would like to know if I can still have a circumcision done at my age. I would like to know the price range to do a surgery and where I can do it. Thank you.

A That is a very unusual consideration/request at your age but yes it can still be done.

Male circumcision, which is the surgical removal of the foreskin, has been dated back to the prehistoric ages.

The procedure is often performed as a part of either a religious, or cultural practice; regardless of the reason, circumcisions are most often performed during the neonatal or prepubertal ages (baby to infant ages).

In the event that Male Adult Circumcision (MAC) is performed, it is usually done for a variety of medical reasons, including various penile pathologies, and disease prevention - mainly sexually transmitted infections (STI's). It is also performed for reasons such as sexual dysfunction as well as for a personal preference.

Depending on the reason for the circumcision, a particular surgical technique and method of aneasthesia will be decided on. The method chosen will also depend on the surgeon and the technique with which he/she is most comfortable performing. All of these considerations will affect the cost of the procedure, as well as health insurance coverage.

The procedure is usually done by a surgeon, particularly a Urologist.

The best way to get an idea of the cost and to learn more about male adult circumcision will be to visit one of those specialists, and to discuss your options.