Story of Guts & Grit – Real Men & Real Women in Public Life – Kay Warren

Love and marriage

I continued in this state of internal conflict and failure, all the while knowing I was in deep trouble. I wanted out but didn’t have a clue how to change. Then I met Rick Warren when I was 17 at a training to be part of a summer youth evangelism team that would travel to Baptist churches in the cities and towns of California. We reconnected a year later as freshmen at California Baptist College, a small liberal arts college in Riverside, California, and became casual friends.

He asked me out to Farrell’s Ice Cream Parlour in the fall of 1973, and I grudgingly went. A week later—eight days to be precise—he accompanied me to a revival. When we got back to campus, we prayed together to close out the evening. Sitting in the dark, I heard him say, “Will you marry me?” I recall instantly praying and asking the Lord what I should do. I heard God respond, Say yes. I’ll bring the feelings. And so with my 19-year-old understanding of life, romance, God, his will, faith, and my desire to be obedient to him, I said yes. Kay Lewis and Rick Warren got engaged.


Not “the perfect couple”

As I walked down the aisle and stared into the shining eyes of the earnest, kind young man who had asked me to marry him, I knew I was loved. The way he looked at me on our wedding day became an anchor I would hold on to during the darker times when I wasn’t sure we were going to survive the mess our marriage had become.

Our brand-new marriage took an instant nosedive. We didn’t even make it to the end of our two-week honeymoon to British Columbia before we knew our relationship was in serious trouble. We had been warned about five areas of potential conflict all couples have to deal with, and we immediately jumped into all five of them: sex, communication, money, children, and in-laws. We were so young—barely 21—and inexperienced, and when sex didn’t work and we argued about sex, and then argued about our arguments and began to layer resentment on top of resentment, it was a perfect setup for misery and disenchantment.

What made it worse was that everyone considered us the perfect couple. When we returned from the honeymoon, already miserable and shocked at the depth of our unhappiness, we felt like we had nowhere to go with our wretched pain and marital failures. I had told Rick about being molested as a little girl—he was the first person I ever told—but because I was so unemotional about it, he figured it wasn’t that significant an incident to me and basically forgot about it. I kept my occasional ventures into pornography a complete secret. Between the effects of the unaddressed molestation, the resulting brokenness in my sexuality, and the off-and-on pornography fascination, it shouldn’t have been a surprise that sex didn’t work.

The weight of misery

Rick and I managed to limp our way through our first year of marriage, all the while he was a youth pastor to a vibrant group of kids who filled our small apartment at all hours of the day and night. We were young enough and naïve enough—and thoroughly conditioned by our strict upbringing—to not recognize the damage we were causing to ourselves by hiding and pretending everything was okay.

On our second wedding anniversary, we moved for Rick to pursue a master’s degree in theology so that he could become a senior pastor. We still had massive problems with sex, communication, and money, and we were in marital hell. The common understanding of the day was if you love Jesus enough, your marriage will be happy. What was so confusing was that we loved Jesus with all our hearts and were committed to the local church. How could things be so bad?

The fact that we were miserable weighed on both of us like a giant boulder, but we didn’t see any way out. I think we hoped that one morning we would just wake up and find it was all a bad dream and that somehow all our problems would simply vanish. We wanted to honor the sacred wedding vows we had made before God and our loved ones, so divorce wasn’t on our radar. But neither could we visualize living in such pain for the rest of our lives. We just didn’t know what to do or how to create a healthy marriage out of the shattered pieces of conflict, disappointment, dysfunction, and resentment.

Sticking it out

Over time, as we both grew as individuals and as we sought counseling together, we began to experience healing in our marriage. Yes, we faced many rough patches over the decades of our marriage, but I’m so glad we stuck it out through our painful first few years. God has worked in our life together—and he’s used our marriage struggles and failures to draw us closer to him and to each other.

Through my decades of ministry, I’ve talked to hundreds of women and couples who were in lonely, unfulfilling marriages—marriages in which their dreams had turned to dust. Where the passion had long since been buried under the daily grind of careers, children, pressure, stress, and unfulfilled longings. Some of these marriages ended with a loud bang as anger and bitterness corroded any sense of decency and humanity and compassion for the other. Some ended with shock, soul-shattering pain, and disillusionment as betrayal made a mockery of the vows of faithfulness. Some ended with a quiet whisper—silence—as boredom, illness, financial struggles, or any other of myriad issues made even dry, brown grass on the other side of the fence look so much greener than the barren wasteland on their side of the fence.

From the trenches

I don’t approach this subject from the Hallmark-card version of marriage but from the blood, sweat, and tears of the trenches where our marriage was forged and is sustained. I know what it’s like to choose to build our relationship; to seek marriage counseling again and again; to allow our small group and our family into the struggle; to determine one more time to say, “Let’s start over” and “Please forgive me, I was wrong” and “I forgive you.” I know what it’s like to admit that my way isn’t the only way to see the world and to try to imagine what it’s like to be on the other side of me; to choose to focus on what is good and right and honorable in my husband instead of what drives me crazy; to turn attraction to another man into attraction to my husband.

I know what it’s like to have vastly opposing opinions on how to handle and cope with a mentally ill child; to have fear and anxiety and panic threaten to swallow up normal life; to become consumed with the needs of one member of the family. I know what it’s like to be cracked open by catastrophic grief and to share it with your spouse when you’re so different; to figure out how to grieve and mourn together when your mentally ill child takes his life in a violent way and your grief is public because you’re in ministry and your glass-house, fishbowl existence is fodder for scrolling headlines on CNN.

We’ve beaten the odds that divorce would be the outcome of our ill-advised union. We’ve weathered my breast cancer and melanoma. We’ve survived the mental illness and suicide of our son Matthew. And now we know. We know we are the best thing that has ever happened to each other. I am in love with the man God brought into my life so many years ago. Each of us is not who the other was looking for, but each of us is who the other desperately needed to become the person we each are today. Yet, it’s also been the very best thing that has ever happened to either of us. We wouldn’t be who we are today without each other. I’m a better Christian, a better woman, a better mother, a better friend, and a better minister because of Rick. He says he’s a better Christian, a better man, a better father, a better friend, and a better minister because of me. The shrieks of iron sharpening iron have often sounded like gears grinding on bare metal, but the result has been profound personal growth in both of us.

Kay Warren is the cofounder of Saddleback Church with her husband Rick Warren and the author of Sacred Privilege: Your Life and Ministry as a Pastor’s Wife. She is a Bible teacher and an advocate for those infected and affected by HIV and AIDS, as well as orphaned and vulnerable children. Adapted from Sacred Privilege © Kay Warren, 2017. Published by Revell, a division of Baker Publishing Group. Used by permission

Wonder Woman – Review by Dr Vishal Mangalawadi

“Men are essential for procreation, unnecessary for pleasure.”
WONDER WOMAN — the “godkiller”
[On a mission to destroy Christianity and the West?]

My wonderful daughter responded to my Father’s Day wish, by giving us a gift card for our 42nd Wedding Anniversary. Ruth, my Amazon (sorry . . . amazing) wife, didn’t object to watching Patty Jenkins directed action movie on our only romantic afternoon out. Ruth’s condition was that we go to Amazon-owned Whole Foods for the anniversary take-out.

I loved the magical and beautiful, compassionate though fierce, daring and deadly, Gal Gadot, who plays Diana, the princess of the Amazon women warriors. She grows up in supernaturally sheltered women-only paradise of mythical Themyscira. Her aunt, the female general, trains her for her life’s mission — war. Because I liked the movie (and because the gift card did not use up all the money), I went back to watch it with my Californian friend, Bryan Prosser.

The enchanted movie has already made $601.6 millions. Therefore, only a bright Mathematician like Bryan could have noticed that a scholarly princess, who had mastered all the twelve volumes on “Bodily Pleasures,” had no idea of what is marriage. Steve Trevor, (the pre-James Bond) spy in World War 1, played by Chris Pine, is a thorough gentleman. He is unwilling to lie down near a young woman because they are not married.

‘What is marriage,’ inquired the princess who had rescued him from drowning, tied to his plane.

‘Couples go to a magistrate,’ explains Chris, ‘and promise to stay together for better or for worse, “until death do us part.’”

“And do they?” Diana asks.

“Not always” Chris admits embarrassingly.

“Then why do they do (marry)?” a bewildered Diana wants to know.

“I don’t know” answers postmodern Chris. His post-Christian culture has no explanation for Christian marriage.

Diana’s mother, Queen Hippolyta, had taught her that men could not be trusted. They don’t deserve her. From Steve she learns that although human untrustworthiness is an observable (scientific) fact, at the end of the day, it is not about what people deserve. One acts in accordance with “what you believe.”

“It is love that saves,” muses the Wonder Woman at movie’s end. For before the end, Steve does muster up the courage to tell her (a feminist), “I love you.” He loved undeserving people too. For their sake he left her: ran on the runway, jumped on to the German plane headed to London, loaded with poison gas. Steve blew up the plane, sacrificing himself in order to save the people from the deadliest weapon ever invented upto that point.

Like English authors, C. S. Lewis and J. R. R. Tolkien who fought in WW1, Diana knew a truth that Steve did not believe: the real reason for humanity’s insane war was supernatural. Zeus, the creator, made mankind in his image. Ares, Zeus son, became envious of mankind because his father loved them. Becoming the god of war, Ares corrupted mankind, filling them with hatred and strife.

Diana believed that by finding and killing Ares, she could end all wars. She killed Ares . . . but the war continued. Diana sensed that the problem was deeper; something was wrong with men themselves. No one, however, had ever explained to her what is wrong with man and how to cure his sinfulness. Like Diana, Postmodern Steve too lacks intellectual means to understand man’s sinfulness.

‘Germans are the bad guys,’ Steve and Diana believed. Indeed, the Germans were making the poison gas with help from the Turks (Ottoman). The Psychopath scientist was female — Dr. Poison. Why would a woman invent the worst weapon ever?

Well, because she was loyal to a man — the German commander, committed to war. His woman gave him the power to become worse than he was. Diana believed that the clod-blooded murderer, the cruel commander, was Ares. So, she fought and killed him, only to learn that Ares was a British leader, the foremost public champion of peace.

Steve Trevor, the spy, was trained to deceive the enemy. Spreading misinformation, called propaganda, was a weapon democracies routinely used against their enemies. Wonder Woman’s viewers know that propaganda is a weapon democracies now use against their own people. In London, Steve’s secretary takes Amazon Princess shopping so that she may be dressed appropriately for a civilised society. “But how can your women fight in such a dress” asks a puzzled Diana.

“We are a democracy,” informs the secretary, “we fight for votes.” Diana cannot comprehend British parliamentarians who appear to be deceiving each other. What she does discovers, however, is that Ares, the god of war, is not a German dictator. He is British, democratic, champion of peace.

There is something true about Post-Truth Wonder Woman. The media has branded American president “Post-fact.” The President has retaliated successfully, labelling investigative journalism, “fake-news.” Secular universities and many “evangelical” theologians have agreed (following Nietzsche, Freud, Jung and Joseph Campbell) that human intellect (logic and Rationalism) cannot lead man to truth. Since there is no revelation from God, therefore, Truth has to appear magically through “story.” Man may not know the truth but deception is definitely there. A Wonder Woman is needed to fight diabolical deception with magical truth-lasso.

Truth is indeed a mystery. A machine may read a brain. It may know precisely which part of the brain is active in a particular thought process or emotion. Yet, as apostle Paul said, the thought itself is known only by a man’s own spirit. (1 Corinthians 2:10-11) Amazon women are wonderful but they cannot know truth in Steve’s mind. The best their magic lasso can do is to force him to confess truth.

When even magicians and telepaths cannot know what is in someone’s head, how can a philosopher know God’s thoughts? Paul goes on to say to the Corinthians that only God’s Spirit knows God’s mind and God’s Spirit can communicate God’s truth to our spirit. Human beings know and communicate truth in words because we are spiritual beings. A worldview that discards spirit has to discard truth also. That is what secular materialism has done by reducing man to soul-less animal– a biological machine.

Neither Steve (a good man) nor Wonder Woman (who knew every thing about bodily pleasures) has intellectual tools to know what marriage is. This is because the West (including much of Western theology) has chosen not to heed God’s word. It was God who told Adam and Eve that their sexuality was intended for something much greater than passing pleasure and procreation. God made them male and female so that they could become rulers over everything on earth. When God brought a naked Eve to a naked Adam, He blessed them to be one: to ““Be fruitful and multiply and fill the earth and subdue it, and have dominion over . . . every . . . thing“ (Genesis 1: 28 etc.)

Men and women are “fallen.” It is indeed an observable fact that they are untrustworthy and undeserving. However, saving them is not about what they deserve. They do need to save from their powerful enemies (“the Germans” and the god of war — the devil). But the Saviour came to save them from something much deeper within their own heart — from their own sin. The ‘family’ is fallen. Lovers hurt and betray each other. Husbands and wives go to war against each other. Yet, Christ’s salvation includes transforming family. Through His word, His church, and His Spirit, God turns sinful family into a school where children and parents learn to fight against Satan and against sin in their own lives and relationships. Marriage is God’s primary school of character. Marriage and family disappoint those who seek “Bodily Pleasures” without character. For the divine purpose in instituting marriage is to make us holy and true like the triune God.

I enjoyed Wonder Woman. The film does with a Greek myth what C. S. Lewis did with another in his novel, “Till We Have Faces: A Myth Retold.” Lewis too used a Greek myth to explore love and faith in the midst of human envy, betrayal, loss, blame, grief, and guilt. He saw conversion as transformation. Lewis enjoyed and used pagan myths, but he knew a fundamental fact which contemporary evangelicalism is blurring: The Good News of the Saviour coming as a baby in Bethlehem, dying for our sin on Calvary’s cross, and rising again from the dead for our salvation is not a story. It is eye-witness testimony. A Christianity that views the Gospel as a “story” sets itself on a course of self-destruction. For, as a feminist story, Wonder Woman has integrity and it is incomparably better told than anything in the Bible. Graeco-Roman myths that Hollywood is reviving were better stories than anything in the Bible. Christianity won over paganism because Jesus and his apostles did not tell stories. They unleashed the power of truth in a religious culture based on stories. (The god of post-modern age has blinded evangelical theologians who cannot see the distinction between ‘stories’ and ‘parables’ that Jesus told.”)

Incidentally, my Father’s Day wish for Wonder Woman was aroused by my friend Rohan Holt. He emailed me the following eschatological review. He didn’t know that I was holidaying (helping Ruth look after our grand-children) in the USA for three weeks:

“Greetings Brother Vishal,

I hope you and Ruth are doing well. It’s Father’s Day here in the U.S… Happy Father’s Day!

I saw Wonder Woman tonight for the second time. Tonight it made me think of you and the eschatology you were teaching in Goa (Jan 4-14, 2017). Have you seen the movie yet?

Towards the end, Dianna (Wonder Woman) is fighting Ares, the god of war. He has her wrapped in metal, imbedded in the tarmac. She feels like giving up. She has already struggled with discouragement when she realized that all men are not good and she has wondered if men are worth fighting for.
While she’s lying there, she remembers the last words of her love interest, Steve Trevor. She didn’t hear the words when he spoke them to her. He has just sacrificed his life to save others from the terrible poison gas weapon that was loaded onto a plane headed for London. He fought to get on board and blew it all up, himself included… there was no other way… he gave himself to save others. His final words to Dianna, whom he loved, was “I can save today, you can save the world.” That’s when it hit me. He’s Jesus and she is the church. Jesus gave himself to save us and to show us that love is the answer. Steve’s love and sacrifice strengthens Dianna and gives her the will to fight and destroy her enemy. Decades later (she appears to be immortal) she still fights for others, though now she knows, and says, it’s love that save them. If he hadn’t sacrificed himself she wouldn’t have known love like that. It’s his sacrifice that makes her the hero she becomes. Very inspiring.

It’s definitely your eschatological view that helped me see the movie this way. Thanks. Please let me know what you think when/if you’ve seen the movie.

Bless you brother!”
[PS – The people who need this review will not read it on my Facebook Page. You can help me turn it into a visual review for YouTube, by contributing on]


Abortion – Crisis of Life – Silent Holocaust – Dr Lalith Mendis

Abortion – Crisis of Life – Silent Holocaust



  1. Contents


  1. List of Tables & Figures
  2. Acronyms and abbreviations
  • Definitions


Unplanned Pregnancy

An unplanned pregnancy is a pregnancy without forethought or is not desired by the couple.


  1. Acknowledgements and resource materials used
  2. Preface



Abortion is a sensitive issue from a socio cultural, religious and legal perspective and a matter of life or death for the woman concerned and sometimes a disastrous event for the family, a dilemma for the practitioner and   major burden to the health economy of the country.

It is estimated that worldwide, one in eight maternal deaths, an estimated 13%, or 67 000 per annum deaths, are due to unsafe abortions or abortions performed under unsafe conditions ,often illegally (1). Many more women suffer from a large number of short term and long term morbidities as a consequence of such abortions.

Unlike illegally performed abortions, spontaneous abortions or miscarriages that occur naturally ,have a very low morbidly rate and hardly any mortality.

Therefore the concern for preventing unsafe abortions or illegal abortions and providing appropriate post abortion care (PAC) is a priority in the minds of all health care professionals and in the agendas of the professional organizations.

The large number of women who risk death, injury, and social or criminal consequences associated with illegal abortions demonstrates clearly ,how desperate they are to avoid a pregnancy which is unwanted by one or both partners.

This brings in to focus ,the unmet need of contraceptive services and choices for such couples which is attributable to many diverse reasons  that operate  at individual, family ,community or national level.






The obvious conclusion that all such deaths and ill health could be prevented by avoiding unwanted pregnancies should be a wakeup call, for all health care providers to review and identify reasons why in countries such as Sri Lanka ,which has achieved  a high  national contraceptive usage rate of  68% with 50% using modern methods (2) some women resort to abortion and  explore all possible avenues to make contraceptive information and services available all couples who need them.

In order to achieve this objective , all categories of health care professionals have to work in unison , while identifying the opportunities, roles and responsibilities, each category of  health care professionals are  endowed with  and make a coordinated effort to help these couples..

The First contact doctors ,namely Private  Practitioners, and  Medical Officers of the Out Patients Department  are in a very strategic position,as there is much opportunity to offer advice on family planning as well as on providing initial Post Abortion Care ,(PAC) referral for further PAC to specialist centers and offer counseling both emotional and contraceptive. , if they had resorted to an unsafe abortion,


Unplanned Pregnancies

Most couples desire  to have children after marriage. The desire and decision to conceive are exclusively personal,for the couple concerned  and be by choice rather than by chance and it should be a happy and rewarding experience which needs to be a planned and well timed event.

When planning a pregnancy physical and mental well being of the mother , availability of time and finances to support the baby , as well as basic information or knowledge on sexual and reproductive Health  are some of the issues that need to be considered. Thus with proper planning a couple can have a healthy baby & and maintain happy relationship within the family.


Unfortunately this  ideal situation does not prevail in some relationships. It is also difficult to assess accurately  the number of unplanned pregnancies occurring in Sri Lanka at national level .




















Unplanned pregnancies are responsible for many negative outcomes at global level as seen in Fig.







There are many reasons for pregnancy to occur when it is not desired, apart from the apparent disregard by the couple to make an effort to avoid one.


Lack of basic knowledge on SRH


Although education in the school intends to impart the basic knowledge on SRH by the use of prescribed modules in the teaching  curriculum ,there appears to be a gap in the implementation .This  results in ,most of the couples engaging in a relationship ,within or without a formal marriage  while  they are not literate on basic SRH .Some will not be not be aware of matters such as the fertile period , the fact that deposition of semen on the vulva could result in pregnancy ,that coitus interruptus or coitus intergracilis behaviours which are likely to result in a pregnancy. The pathetic situation is an unwanted pregnancy when they least expect it.

Although free and easily accessible information is available ,  it is uncommon to find couples accessing them ,particularly when they are young or unmarried even when they  are in a sexual relationship possibly due to the fear and stigma attached to sexual issues in the country


This is more significant with women and girls who bear the burden of an unwanted pregnancy.

Sexual abuse or rape : Lack of choice.


It is well understood that pregnancy after rape or incest ,certainly is unwanted and disastrous to the woman concerned. The provision of Emergency Contraception as an important management option to rape survivors , but is not often practiced

Similarly ,unwanted pregnancy ,within a relationship burdened  with ,domestic violence is common and often the woman resorts to an  unsafe abortion


Contraceptive failure

An unwanted pregnancy can occur due to the  failure of a contraceptive method either due to its inherent weakness of the method or due to its  to incorrect and inconsistent use .


Non Use of Contraception

This is possibly the commonest cause for unwanted pregnancies .This   is due to lack of information, lack of access and fear of complication often due to the misinformation and myths regarding the method.

Unfortunately some, if not most of these unwanted pregnancies end up as illegal and unsafe abortions with dire consequences to the mother, family and in a wider context to the society at large.
















Magnitude of the problem of illegal hence unsafe abortion

Where there is a restrictive law on abortion it is difficult to get accurate frequency of illegal and presumably unsafe abortions. Most, if not all ,illegal abortions are done by providers who do not have the necessary skills and in unhygienic conditions therefore considered unsafe.

Many researchers have estimated the incidence of illegal abortions and there is evidence  that a large number of abortions are performed in Sri lanka at present .

A survey carried out in the year 1999 showed an abortion rate of 45/1000: 38-52/1000) women in the 15-49 year age group. This rate translates into an abortion: live birth ratio of nearly 71% and estimates near 250,000 abortion attempts for a year2.

Another researcher has estimated that around 650 cases of abortions are taking place in a day in Sri Lanka. This will amount to about 125 000 – 175 000 abortions annually. This when compared with the annual births of 370,000 live births extrapolates to every 2 fetuses are aborted for 3 babies born, in Sri Lanka.

When such large numbers are estimated to be performed ,it is of concern as to whether some families are using abortion as a method of family planning ,though illegal and dangerous


Sri lanka has a maternal mortality rate  of 38 for 100,000 live births (4) a low value compared to the rest of the developing world.

Although the total number of maternal deaths occurring in Sri Lanka is low compared to other developing countries ,the contribution from unsafe abortion remains considerable and is the second or the third common cause of maternal deaths . Fig 1







It is also important to note that for every death due to abortion many women will suffer physical and mental disability and may suffer from subfertility secondary to the unsafe abortion


  1. Profiling the abortion seeking couple

Situation Analysis  which looked in to the available literature in order to identify strategies to address the issue of unsafe abortion found that there was no predominant ethnic or religious groups among the abortion seekers.

Commonest pregnancy, targeted for termination was the third and in contrast to the commonly held belief that abortion is common among adolescents, it was not so, with different studies quoting figures ranging from 2.9% to 8% (average of only 4%).

It is also noteworthy that more than 90% of abortion seekers were married, contradictory to the common belief that it is a problem “usually of the unmarried”

There was no correlation of its prevalence with the level of education or the occupation of the abortion seeker

However it is important to recognize that some subpopulations or sub groups of women and girls, may be in circumstances that make it difficult to make safe decisions and choices which make them , more likely to face an unwanted pregnancy.

In this regard  young women moving out of the secure environment of their  families to an alien  setting for education or employment  form an  important groups to be considered for  strengthening  their life skills and  RH knowledge .








The common reasons for which couples seek abortion are given in Fig   . It is evident that most of these unwanted pregnancies that had been aborted could have been avoided by the use of an effective method of family planning.




The decision made by the couple, often jointly ,,is the end result of many complex pressures that are made to bear on them ,through their personal, family and sociatal commitments ,and burdens . Some of these are illustrated in the Fig      . It  is important that the care provider recognizes that, the woman who seeks or undergoes an illegal and hence unsafe  abortion is an individual caught up in this complex web . The care provider she should not be judgmental, from the point of view of the moral or legal standing.

















Providers of unsafe abortion and the methods used

Understandably it is difficult to get detailed information on the providers, because of the strict legal restriction of abortions. Some studies have identified menstrual regulation, by way of suction and D&C as common methods used but under illegal under unsafe conditions. However it is important to recognize that some women still rely on backstreet abortionist who use traditional methods such as introducing foreign bodies and harmful liquids which often leads to injuries that may prove fatal.





One of the common drugs used in the mistaken belief, that it will cause abortions is progesterone marketed under different names, which actually does not disturb an established pregnancy. Thereafter the couple fear that the drug taken would cause the birth of an abnormal baby,, which in turn makes them more desperate  in their attempt to get rid of the pregnancy.. Such drugs which are meant as pregnancy tests of the olden days should not be used  when very sensitive pregnancy tests are available.

Drugs used in other countries for medical terminations are not available in this country as using them for procuring an abortion is an offense punishable by law. However clandestine operators may be using some of these drugs..


Consequences of unsafe abortion

Apart from the death of the woman due to unsafe abortions, there are many medical complications that may occur.

The risk of the woman dying or having medical complications is related to the following:

  • Method Used : More with insertion of foreign bodies
  • The skill of the abortionist :Less skilled the provider is higher the risk
  • Period of gestation :Higher the POG greater the risk.
  • Accessibility of care :Geographical, financial and attitudinal constraits.
  • Time gap from the onset of symptoms to accessing the  first contact point Practitioner : Higher the delay Higher the mortality ad morbidity
  • Attitude, knowledge and the response of the first contact point Family Practitioner: Morbidity is high when stigmatization of women with unsafe abortion is more.


Major complications, namely hemorrhage, sepsis and injury to internal organs, if left untreated can lead to death.

The commonest complication, however is the retention of products of conception                             (Incomplete abortion) which can lead to the aforementioned sepsis and hemorrhage.






All these can be considered as occurring immediately or within a few days.

Women surviving these complications often suffer life-long disability or face elevated risk of complications in future pregnancies or may become subfertile

Occasionally the woman may go into shock at the time of the interventions that are associated with the dilatation of the cervix and may die on the abortionist’s table..


Septic abortion usually result when the endometrial cavity and its contents become infected usually after contaminated instruments or foreign bodies are inserted into the cervix or when products remain in the cavity . The general symptoms, women with sepsis have fever, chills, and foul-smelling vaginal discharge. High fever with tachycardia and tahypnoea and low blood pressure  should alert the first contact point professional ,that the patient is in septicemia and that she will possibly needs admission for critical care .



Hemorrhage could be external which is noticeable and assessable or internal which is concealed and makes it difficult to assess for the general practitioner..

Retained products is the common cause for virginal bleeding

Possibility of an internal hemorrhage needs to be thought of when the tongue and mucosa is pale in contrast to the women with sepsis whose tongue is pink. The patient with internal haemorrhage too will have other signs such as tachycardia, hypotension with evidence of abdominal distension tenderness and guarding.

Possibility of an ectopic pregnancy also needs to be thought of, with such clinical picture.

In both these situations the practitioner has to recognize the critical and immediate danger, the woman is in and transfers her to a hospital with specialists, urgently



Damage to internal organs

These women often present with evidence of damage to internal organs or with signs of peritonitis either due to bowel injury or to infection introduced during abortion. They will have signs of peritoneal irritation such as tender, tense abdomen with or without rigidity.

Most oft these patients present soon after an abortion, but occasionally injury to bladder may present as a fistula with leakage of urine or feces much later.

Long term consequences include the following

  • Chronic Pelvic Infections leading to chronic abdominal pain and debility
  • Intra uterine synaechae leading to secondary amenorrhea
  • Secondary subfertility due to tubal damage.
  • Higher possibility of ectopic pregnancy in a subsequent pregnancy
  • Higher chance of a placenta previa if scarring of the uterus had taken place
  • Rupture of a uterus at subsequent labour if scarred.

Emotional burden to the couple, particularly to women

Even though the decision to abort is made owing to many pressures, both partners often regret the decision. This leads to many negative emotional responses such as regret, depression and fear.


Non medical Consequences


The economical burden at individual level is remarkably high at present costing three to thirty Thouend Rupees depending on many factors one

What is often not recognized is the cost to the state of providing PAC including  surgical interventions and ICU care .























Possible points of intervention in the pathways leading to unsafe abortion

The General practitioner is in a strategic position to offer SRH information including that on contraception and provide such services as a way of preventing unsafe abortion.

He / She is trusted by the clientele ,including adolescents and youth ,who are very sensitive and secretive when it comes to discussing RH issues. He / she would be in a tactical position to open up a discussion about relationships and discuss the basic RH information and intimate them on the possibility as well as on the risk of pregnancy ,initially ,even on a hypothetical basis The ability to win their confidence by respecting their views is the key to subsequent care provision ,which may save their life from a very dangerous situation

Similar opportunities are offered when providing antenatal care, post natal care , immunization to babies , well women services such as pap smear screening

Fig attempts to summarize such possibilities






















Figure 2





Figure 1 Possible Points of intervention to prevent an unsafe abortion






Postabortion Care (PAC)


PAC is a way of providing women comprehensive and holistic after care for complications arising from an abortion whether it being spontaneous or induced. It was recognized as a main element of women’s health programmes in 1991. Since then it has been recognized as a measure of improving the standard of health care for women by international organizations, and implemented by several countries as pilot projects or as a matter of health policy.

It is estimated that 1 in 8 pregnancy related deaths occur due to complications following an abortion and these deaths could be prevented if basic care is given at the right place at the time at an affordable price.

The importance of PAC was recognized by the 1994 International Conference on Population Development (ICPD), which stated in its report; that

“….in all cases, women should have access to quality services for the management of complications arising from abortion. Postabortion counseling, education and FP services should be offered promptly, which will also help to avoid repeat abortions” (ICPD paragraph 8.25).


Elements of Post abortion Care

The aspects of care identified in the original PAC model are:

  1. Emergency treatment of incomplete abortion and potentially life threatening


  1. Post abortion FP counseling and services
  2. Links between Post abortion emergency services and the reproductive
    healthcare systems
  3. Community and services provider partnerships
  4. Counseling






  1. Emergency treatment of incomplete abortion and potentially life threatening Complications

Provision of emergency treatment (medical assessment, stabilization and pain management) and uterine evacuation, or referral after stabilization to an institution where evacuation facilities are available, can reduce the number of deaths and disability caused by incomplete abortion and its complications.


  1. Post abortion FP counseling and services1

Increasing number of unsafe abortions can be an indicator of the prevailing need for contraception (unmet need) in the community. A wide range of contraceptives should be available at ward/facilities, to provide women a method of their choice to prevent the vicious cycle of repeated pregnancies and unsafe abortions.


  1. Links between post abortion emergency services and the reproductive
    healthcare systems

There should be linkages between the facilities providing emergency care and other institutions providing treatment for STI’s, cervical cancer screening, infertility services and ante natal care. These linkages can help in active referral of patients for services in their respective areas which would be important for a continuous follow up of these women.

During PAC is the best occasion to inform about safer sex, FP and other RH issues.


  1. Community and Service provider partnerships

Partnerships with community leaders, lay health workers, advocacy groups and other formal health service providers should be made to increase access to PAC. Components of a successful partnership includes education to increase the uptake of contraceptives, mobilization of local resources to assure timely care for obstetric emergencies, making services accessible to women who are marginalized (adolescents, living with HIV/AIDS, commercial sex workers, in abusive relationships and who are physically and mentally vulnerable), calling for rights based  reproductive health policies addressing needs, priorities and expectations of local communities and participation on decision of affordability, accessibility, availability and sustainability of the service.


  1. Counseling

Addresses the woman’s needs on;

Issues of emotional and physical wellbeing

Decisions about pregnancy


Aafter care

Resumption of fertility

FP counseling.


Importance of PAC

PAC is simple, effective and cost efficient way of preventing maternal morbidity and mortality. This reduces the cost incurred by the government while early recovery helps the woman to go back to her daily routine.

FP counseling and service provision increases the uptake of a method, preventing further unwanted pregnancies and repeated abortions. This also provides an opportunity to address multiple health needs of women through the collaboration and referral to other reproductive health services.


PAC and abortion are not the same. Though abortion law is restrictive, providing care (PAC) to a woman after an abortion (spontaneous or induced) is not illegal and it is a human right as this will save the LIFE OF THE MOTHER and reduce complications (early and long-term due to abortions).


PAC should therefore be an integral part of all essential obstetric and newborn care programs.


Factors That Affect Whether Women Seek Postabortion Care


Factors That Affect Whether Women Seek Postabortion Care


There are several socio-cultural elements that can influence whether a woman seeks care after an abortion. These can affect the woman’s ability to make informed decisions concerning care,


  1. Women’s ability and willingness to seek care promptly:


Permission from their husbands or parents/guardians – financial


  1. Access to postabortion care services:


Because of the personal nature regarding PAC care services, women may be reluctant to choose facilities where friends or neighbors may recognize them. Also, accessibility of health services in their area may be limited.


  1. Providers’ attitudes toward postabortion care needs of women and youth:


Providing empathy and support improves the quality of PAC care.


Health care providers should not exhibit judgmental, harsh or unprofessional behavior. Rather, it is important that they provide care that is gentle and supportive, encouraging the woman/youth toseek, rather than hide from, medical help.




Delays in Seeking Care


Factors affecting why women seek care are also related to preventable delays. These include delays in:


Recognizing that a problem exists:


Many feel that certain problems are “normal” in pregnancy, e.g., bleeding in pregnancy, etc.


Some women may not know they are pregnant (especially adolescents or women pregnant for the first time) so are unaware that the problem is pregnancy-related.


Deciding to seek care:


Gender/family roles may dictate who decides when a woman seeks care.


Women who have received poor quality care in the past may be reluctant to seek care.


Women suffering from abortion-related  complications may fear reprisals or negative attitudes from family, friends, health staff and the community.


The cost of services may deter youth and women from seeking services.


Reaching care:


Women in rural populations may have little access to transportation, and roads may be poor, especially during rainy seasons.


Women may not have the funds to access transportation.


Receiving care once they arrive at the facility:


Many facilities do not offer all components of PAC.


Lack of a triage system may aggravate delays in treating priority clients.


Under-staffed and poorly equipped sites may result in treatment delays.


Service providers may have negative and punitive attitudes toward postabortion clients, particularly youth or unmarried women, which may lead to more delay in providing services.


What can the GP do?

According to the existing restrictive law on abortion the main part a GP can perform is to reduce the unmet need for contraception – which is one of the main root causes for seeking a termination by taking the time to talk about the family size, fertility and what they do to prevent a unplanned pregnancy at each opportunity. As to most persons the GP is someone who they would trust and confined in.

If someone comes seeking for termination the GP can talk thru the harm reduction model, where they enlighten them on the law regarding abortion, what would happen if they do seek a termination, give a sympathetic ear to their concerns – as deciding to go thru with a termination is a big decision which some would regret for as long as they live.


Post Abortion FP methods:

It should be emphasized that the fertility returns as early as two weeks following an abortion/ termination, and that the woman can get pregnant again if she does not use a FP method.

A FP method can be usually commenced 7 days after an abortion/ termination.


Method When to start
Condoms Immediately after the abortion
Oral Contraceptive Pill Within 7 days of the abortion
DMPA Within 7 days of the abortion
Implants Within 7 days of the abortion
IUCD Within 48 hours or 6 weeks after the abortion
Female Sterilization Within 48 hours or 6 weeks after the abortion if another pregnancy is not desired
Male Sterilization If another pregnancy is not desired anytime during the pregnancy or after the abortion




Basic facts about ‘family planning’

What is family planning?


Family planning is having children by choice and not by chance. It helps couples to have a desired number of children by appropriately spacing and limiting pregnancies and thereby enrich family life. Having a child by choice and nurturing the child with love and care will help the child to grow well and be a happy member of the family.


What are the objectives of family planning?


  • Help couples to postpone the first pregnancy
  • Help couples to space pregnancies
  • Help couples to limit their families



Planning a family is the first step towards a happy life for the whole family


A ‘planned’ family
An ‘unplanned’ family


Limiting the number of children in the family and adequately spacing them (with at least 3 years apart) are both important for a happy & healthy family life.




Modern family planning Methods


Modern family planning methods refers to the correct use of contraceptives. Contraceptives are devices or drugs that are effectively used to prevent pregnancy, while allowing sexual intercourse. Contraceptive counselling and services could be obtained from Public Health Midwives, Medical Officers of Health, General Practitioners and Specialists.



What are the modern family planning (FP) methods available for couples?


Modern FP methods are classified into Temporary and Permanent methods.


Temporary Methods are;
a) Hormonal contraceptives
I.        Combined oral contraceptive pills (COC)

II.     Injectables (DMPA)

III.  Subdermal implants


b) Non hormonal contraceptives
I.        Intra uterine contraceptive devices (IUD)

II.     Condoms (Barrier method)


Permanent Methods are;
I.        Female sterilizations

II.     Male sterilizations


In addition to the above mentioned methods  Emergency Contraception or Post Coital Contraception is also available for those who have had unprotected sexual intercourse.


Important: A family Planning method should be offered to couples after appropriate counselling so that the couple should be able to make an independent, informed choice about a FP method. If a couple is not satisfied with one method they should be able to change to another. Family Planning should be by choice and not by coercion.




a.) Hormonal contraceptives

Definition: A preparation of synthetic steroidal female hormones (progesterone combined with oestrogen or progesterone alone) administered systemically.



  1. Oral contraceptive pills (e.g. Combined oral contraceptive)
  2. Injectables (e.g. DMPA-Depot Medroxy Progesterone Acetate)
  3. Subdermal implants (e.g. Jadelle)


  1. Combined Oral Contraceptive (COC) Pill

The COC is one of the commonly used hormonal contraceptives used in the national family planning programme. It consists of synthetic hormones that are similar to those that occur naturally in a woman.


Each packet contains 21 pills of low dose oestrogen and progesterone in constant amounts and 7 placebo pills containing iron.


The COC is suitable for:

  1. Newlyweds (e.g.  teenagers- to postpone the birth of the first child)
  2. Spacing between pregnancies
  3. Limiting family size when other methods are not acceptable
  4. Unmarried sexually active women


Effectiveness- 92% (If 100 women use this method for one year, it will prevent pregnancy in 92)


Return to fertility-No delay in return to fertility


N.B. There should be no break in taking pills between packets if effective contraception is to be achieved.




  1. Injectables-Depo Medroxy Progesterone Acetate (DMPA)

DMPA is a long acting progesterone preparation of 150mg, given deep intramuscularly in a single dose. DMPA has a contraceptive action for 90 days and does not have the undesirable oestrogen related side effects.

The DMPA is suitable for:

  1. Spacing between pregnancies
  2. Limiting family size
  3. Lactating women after 6 weeks post partum
  4. Those awaiting sterilization


Effectiveness– 97% (If 100 women use this method for one year, it will prevent pregnancy in 97 women)


Return to fertility- 7-12 months after the last injection.


III. Subdermal implant –Jadelle

Jadelle is a long acting reversible progesterone only contraceptive delivered by means of two rods, placed under the skin in the inner aspect of the upper arm.  Implants provide contraceptive cover for 5 years.



Jadelle is suitable for:

  1. Postponing pregnancies
  2. Limiting family size
  3. Those awaiting sterilization
  4. Those who cannot use IUDs, COCs or Injectables
  5. Those who cannot use contraceptive methods containing Oestrogen.


Effectiveness- more than 99%

If 100 women use this method for one year, it will prevent pregnancy in more than 99 women)



Return to fertility- Immediate after removal.



  1. b) Non–hormonal contraceptives


  1. Intra Uterine contraceptive Device (IUD)


The IUD is a small flexible device, made of plastic and copper that has a contraceptive action for 10 years. The IUD is placed easily in the womb by trained medical personnel with no pain to the woman. The IUD used in Sri Lanka is the Copper T 380 A (TCu-380A).


Secondarily it prevents implantation by producing an inflammatory reaction in the endometrium.


Effectiveness– more than 99%

If 100 women use this method for one year, it will prevent pregnancy in more than 99 women)


Return to fertility- Immediately after removal of the IUD.


  • This method is ideal for spacing and limiting pregnancies.

  1. The Male Condom

The condom is a thin rubber sheath made to fit the erect penis. Condoms are lubricated, rolled, individually packed in foil and ready to use.


Mode of action

Prevents sperms from entering the vagina.


The condom is suitable for the following:

  1. When other reversible methods are contraindicated.
  2. Couples practising infrequent intercourse.
  3. As a backup method with other modern contraceptive methods or traditional methods.
  4. Following vasectomy.
  5. When protection is needed against STI/AIDS.


Effectiveness 85% (If 100 women use this method for one year, it will prevent pregnancy in 85 women)


Return to fertility- Fertility is not affected.


N.B. The condom should be worn before intercourse or any genital contact and a new condom should be used for each act of intercourse.



Permanent methods


The permanent methods of family planning are female and male sterilization. These are surgical procedures, which are effective, safe and economical and are carried out in both developed and developing countries.


I Female sterilizations

Sterilization in a woman involves a minor surgical procedure that results in occlusion of both fallopian tubes and prevents the union of the sperm and ovum.


Effectiveness- more than 99% (If 100 women are using this method, after one year of use, less than one woman will get pregnant)


It is suitable for:

  1. Those who have completed their families.
  2. Certain high risk groups such as:
    1. Women with a history of serious obstetric and medical complications.
    2. Those who have undergone repeated caesarean sections.
  3. Women who are at risk of producing congenitally abnormal children.

E.g. Thalassaemia major


Women who are willing to undergo sterilization should be well counselled.

Female sterilizations are performed by Gynaecologists and Trained Medical Officers.

II. Male sterilizations (Vasectomy)

Vasectomy is a simple operation that blocks the two small ducts, which carry the sperms produced in the testes, and prevents the sperms from mixing with seminal fluid.


Effectiveness- 97% (If spouses of 100 women are using this method, after one year of use, less than one woman will get pregnant)



SRH Case Studies:

Family Practitioner (FP) – In this role many opportunities arise during consultations to have informal conversations where awareness & knowledge can be shared with the client.

Often the FP is the first line of contact. Clients/patients often think of getting advice from the FP during decision making for happy events as well as for adverse events.

The relationship the clients have with the FP is unique. Often it is a long standing association.

The FP must always have in mind the following features for clients –

  • Sufficient time for the consultation
  • Privacy
  • Opportunity for the client to ask questions or confide
  • Pick up triggers – hesitant , fidgeting , loss/gain in weight, over confident
  • Pay attention to unspoken cues – facial expression , pallor , unclean, disheveled
  • Ultimate decisions must be made by the client
  • Never try to impose your views

All these cases are from FPs. The names & ages have been changed to maintain confidentiality.


  1. Nelun comes to you for advice. She is not sure whether to start another pregnancy. If she gets pregnant will Ajith want the baby? She wants to know her options if he does not.

Ajith 32yrs & Nelun 28yrs   have been married for 5 years. Their daughter is 2 yrs.  Nelun comes home immediately after office to  spend time with the baby.

Recently Ajith has got a new job with a fantastic remuneration package. Now he  works late & has a lot of entertaining. Often he has no time and energy to enjoy the money he earns. Nelun always earned more until  Ajith’s new job. It was Nelun who encouraged, paid and supported him to do the MBA which secured the new job

Ajith’s assistant Kumari 21yrs is  dynamic, smart & single. They get on very well. Ajith gives Kumari a lift home  especially if they work late or entertain.

Nelun feels hurt and let down as Ajith is always tired when at home. He hardly spends time with Nelun and the baby. He is away even on weekends or holidays, due to work /workshops/ get-togethers etc. Ajith even forgot their wedding anniversary. He gets irritated when Nelun wants to chat about his new office or airs her views.

Nelun is wondering whether another pregnancy will bring Ajith closer to her?

As her FP what would you do? Will this be a wanted or unwanted pregnancy for both?

– Encourage Nelun to have a chat with Ajith about a 2nd pregnancy

– Try to get Ajith to your clinic to discuss about Nelun’s loneliness & the 2nd pregnancy.  At          least arrange for a phone chat.

– If Nelun decides to go ahead with the pregnancy even without Ajith’s consent she will                 need counseling & support.

– If she decides otherwise make her aware of the legal situation  & counsel both to make the pregnancy a wanted one


  1. Amanda 26yrs is Tony’s childhood sweetheart for the past 12 years. Amanda is a receptionist and her interests are clothes, music and chit-chatting. Tony 26yrs finds this boring and increasingly irritating.

Jackie 24yrs works with Tony and sits next to him. They share a lot in common. She is witty and intelligent. Tony is attracted to Jackie and enjoys her company. Tony feels guilty about Amanda for two reasons – going back on his word and the intimacy they have shared. Tony comes to you as Jackie has just missed her periods.

What can you do ? –

– Help Tony to have a realistic discussion with Amanda

– Check Jackie’s LMP &  her period pattern. Check urine HCG appropriately

– If urine test is positive, counsel both to make this baby a wanted one

– Inform them about the legal situation


  1. Munasinghe, Aruni’s mother comes to her FP for advice as she is worried about her daughter.

Mohan 24yrs and Aruni 32yrs have worked together for 6 months & have fallen in love. Aruni is  from an upper middle class family. Her parents gifted a car to her for completing CIMA .  She is planning a holiday in UK to spend Christmas with her brother and family.

Mohan is a good looking guy who plays club rugger. He completed his A-levels in a Colombo school and got selected for the job  due to his rugger. He understands English and can manage to speak a little. Life is a struggle for Mohan, who lives with his family in a flat in the outskirts of Colombo. His parents are simple folk who work for the Municipality. They are apprehensive about the relationship saying the differences are too many.

Aruni feels she can convince her parents, polish up Mohan as  love conquers all. Mrs. Munasinghe is concerned that Mohan might entice Aruni to have a physical relationship in order to bind Aruni to him.

What advice can you give to –

Mrs Munasinghe –     To bring Aruni for a chat

  • Listen to her concerns
  • Try to allay her anxiety
  • Not to pressurize Aruni which might drive her to a hasty decision

Aruni – Think seriously about the differences- social, rapport with his family, for the kids                                                                              the differences between grandparents, will he fit in with her friends/ associates, age etc

-The physical excitement of the relationship last usually for about 2yrs.It is the bonding      that is long lasting

– Good opportunity to discuss and counsel on fertility and contraception.

– Methods most suitable – Condoms mainly for protection from STI/contraception – OCP, Jadelle(can be removed when needed) ,Standard day Method – not reliable



  1. Kishan is 23 years and registered to Varuni an 18yr old selected by his parents. Fiona 21yrs is attractive & works with Kishan. She interacts well when necessary but keeps to herself most of the time. Her work is very accurate and dependable.

Rohan her boss depends on her accuracy. Recently Rohan noticed errors in the data   compiled  by Fiona. Rohan was baffled. Although he had a chat with Fiona to see whether she was under stress at office or home, he drew a blank.

Everyone in office had observed that Fiona was quieter and more withdrawn recently. They also noticed a couple of bruises on her, which she claimed resulted from a fall.

Fiona comes to you for advice as she has been seeing Kishan. It seems that Kishan becomes abusive when he can’t have his own way. Fiona is worried about an unwanted pregnancy.


What can you do to help?  –  The abuse must stop. Kishan needs counselling

Help is available at the area Police Women’s desk. They are discreet & very            helpful

WIN (Women In Need), 20 Deal Place, Col 3. Phone- 4718585; 2671411

Basic outline on SRH & how the body works

Contraception – Condoms mainly for protection from STI, OCP , Jadelle


  1. Lucky 29yrs and Thush 26yrs appeared as the ideal couple when they fell in love and married. They had everything- looks, education, money, family, jobs etc.

Thush was uneasy after 6 months into the marriage. Lucky was charming, kind, thoughtful and good to her. They had a good relationship and she had no complaints.

Yet she was worried. She was not comfortable with his easy manner with their driver Pradeep.

Lucky is an exercise fanatic and plays tennis daily. He spends a lot of time daily with Gamini 45yrs his tennis partner. Even when he is at home he chats on phone or SMS’s Gamini constantly. He  claims to need his own space and time, that he cannot spend all his spare time with Thush.

Thush is anxious to start a family yet apprehensive. She comes to you her FP foe guidance.

As their FP how will you assess whether the pregnancy is planned/ unplanned or wanted/ unwanted by Lucky and Thush ?

  • Counsel both
  • Try to ascertain Lucky’s sexual orientation, his plans etc
  • Thush needs to evaluate the pros & cons of her anxiety

Can she cope with her anxiety when a child is born?

Is the bonding strong enough to withstand the doubts?

A child will not drive the anxiety away etc

–      Contraception  – Condoms mainly for protection from STI/contraception

OCP, Jadelle until Thush clearly understands the situation


  1. Lalith is a 22 year old swimmer. He meets Kate 39 years with her son Johnny 12 years at the pool. Johnny  bonds well with Lalith.

Johnny invites Lalith for his birthday. Then  Lalith realizes that Kate is separated and lives with                              Johnny in a really stylish condo. Kate’s lifestyle is affluent and comfortable. With time Lalith and Kate developed an attraction for each other. Lalith stays overnight whenever possible and is planning to move in permanently.

Lalith’s parents are totally unaware of these developments. He makes it a point to phone them when staying overnight. His excuses are swimming practices, working late, etc, saying he is staying with Dushy who has a car. Dushy covers up for Lalith as required.

Kate is your client for many years and is friendly with you. Now she claims she needs contraceptive advice for a friend. Through the grapevine you have heard about Lalith.

What would you suggest?

  • If you know her well enough, ask her about Lalith saying you heard from a concerned friend.
  • Listen & counsel appropriately keeping Johnny’s well being in mind
  • Contraception – Condoms – mainly for protection from STI

OCP,DMPA, Jadelle, IUD

  1. Gemunu 46yrs and Lali 42yrs work together. Both are happily married. With time they begin to enjoy each other’s company , discuss good times and the bad. Problem sharing, advice and support is a common occurrence. Gemunu’s wife Nalini seeks your advice about another pregnancy. Nalini has two girls, 14 yrs & 12 yrs. She is hoping for a boy with the third pregnancy to carry the family name. Gemunu has been encouraging her to meet you for advice.

Unknown to all concerned Lali has confided in you that her periods have been delayed by 2              weeks & the possibility of the pregnancy being attributed to Gemunu.

As Lali’s FP what is your  advice to her?

  • This is very difficult. Lali needs to decide about sharing her pregnancy with her husband.
  • A genetic test may allay her anxiety about the paternity
  • She should inform Gemunu as well prior to decision making.
  • Appraise her about the legal situation in SL



What advice to Nalini ?

  • Gemunu needs to be actively involved in the decision about the 3rd


–      As a FP you must allow the clients to make their own choices.

–      Guide them about the legal aspects & health issues.

–      Give psychological support & listen.


  • Noeline 46yrs and Sanath 49yrs have been married for 20 years. They have 3 children – 2 girls and a boy, aged 19, 18 and 10 years. 2 years ago Noeline removed the IUCD after 10 yrs. She did not use a contraceptive as she felt there was no need for one at her age & as the family was complete.

When her periods  delayed by a month  she thought it was menopause. However she came to you for advice. On checking her urine HCG it was found to be positive.

How will you advice her?

  • Counsel her to allay her anxiety & ?shock/supprise
  • Try to make this a wanted pregnancy.
  • Get the support of the husband
  • Offer to chat with the children
  • Postpartum contraception – LRT/Vasectomy

Jadelle, IUCD

9.Rohan 30yrs and Ruwani 28yrs have been married for 3 years. Their daughter is 1 1/2 yrs. They have started to build their first home & want contraception for at least  4 – 5 years.

What is your advice as a FP to prevent an unplanned / unwanted pregnancy ?

  • OCP, DMPA , Jadelle.
  • IUCD – can be removed when needed
  • Properly used condoms

10.Aiyesha 24yrs and Mohamed 25yrs are  getting married in one week. As they are  doing exams   they  want to postpone the first pregnancy for 4 -5 years.

What would you recommend ?

–      Check  whether they are willing for a modern method

  • OCP, Jadelle
  • Condoms –properly used
  • Standard Day Method  – if they prefer a natural method

– not a reliable method.


  1. Marie 28yrs in the 7th month of her 2nd pregnancy has visited her FP 3 times during the past month with vague complaints. Examinations & 2 VOG records reveal nothing.

Tearfully she confides that son Ajith 7yrs is asking embarrassing questions as how did the baby get into your tummy? How will the baby come out?

What advice will you give her?

– Give her age appropriate answers for Ajith –

Doctor Uncle will take baby out from tummy or below with a small cut.

I can show you the cut if it is in the tummy.If down below I am shy etc

If she is reluctant to talk to Ajith say to bring him to you.

– This is a good opportunity for post partum contraception

– Natural protection lasts only for 6wks

– Lactational amenorrhoea method need 3 criteria to work

– OCP , DMPA , Jadelle , IUCD , Condoms

– Standard Day Method – not very reliable


  1. Sujatha 13yrs reached menarche at 11yrs.She was a happy go lucky girl. Now she is quarrelsome & resentful. Her grandmother Shalini is worried & brings her to you for a chat as her parents are busy professionals. They say these are growing up problems that will sort out.

Sujatha is big made & looks older than her age. Due to this she is never left on her own. Sujatha resents this & wants her privacy & freedom.

How will you deal with Sujatha?

  • Show pictures & explain the reproductive system
  • Explain the menstrual cycle & about fertility.
  • The dangers/possibility of an unplanned/unwanted pregnancy
  • Hormonal changes & brain immaturity of adolescents
  • She will then understand the reasons for her lack of freedom.
  1. Sita comes crying to your clinic saying she found her 15yr old daughter in a compromising position with her 19yr boyfriend at 2am that morning. She is fearful of her husbands reaction.

What can you do? –

For Sita              –  Allay  anxiety & fear

–  Check on the daughters LMP

–  What ever the outcome give her  2 tabs “ Postinor 2”

–  Monitor the next period of the daughter

–  Persuade to share the incident with  husband

For daughter      – Counsel

– SRH education / STI

  • Awareness about the possibility of a pregnancy
  • Depending on the pros & cons a contraceptive on a long term basis


  1. Anula 57yrs has a stable marriage with Jagath 62yrs for the past 35yrs. Their 4 children are married & live separately. Jagath had led a busy life until retirement 2yrs ago. Now he spends most of his time on the computer.

Anula had come across a lot of pornographic material while using the computer the previous day. She is upset & shocked at Jagath’s behaviour at this late stage of their life.

She is emphatic that Jagath or the children should not know about her discovery.

She has many questions   –      Where has she failed?

  • Was he promiscuous during younger days?
  • Had she been blind to his infidelity?

How can you help ?            –      Check on Jagath’s  health

  • Has he any NCDs/medications that might affect his sexual function
  • Have an informal chat the next time you meet Jagath & try to gently assess his needs.
  • Pornography is a modern addiction
  • He might be getting some satisfaction by watching these films as his performance is poor.
  • Counsel ,support & listen to Anula as she can get depressed as she will bare this situation alone

15.Ruwani 16yrs is a computer wizard & a good student at school. Her mother Ramani 42yrs comes to you as she is worried. Ruwani’s grades at school have dropped ,her only interests are the Facebook & texting on the mobile. Ramani has managed to  look at her Facebook account & mobile phone with the help of a nephew. She is devastated by what she has learnt. Ruwani’s contacts are all older males & females. Their suggestions are questionable. Ruwani speaks to these contacts on the mobile. Ramani is sure she meets them too.

What are your suggestions to help ?

–     Discuss a plan with Ramani & her husband on how to talk to Ruwani

–      Parents to speak with Ruwani & negotiate a plan

–     Gently talk with  Ruwani involving the parents

  • Get 1-2 persons she trusts to talk with her
  • Take some precautions to limit access to the computer/mobile phone
  • Motivate her back to studies & other activities
  • Parents to spend more time with her
  • Atmosphere at home must be pleasant.

A summary is given below with client details & issues:



Case Male age Female age Married Partner /s Children Kids previously Issues
1 32 28 yes 21yrs 1  –  Extramarital
2 26 26 no 24yrs  – 2nd affair,+ve Urine HCG
3 24 32 no no  – Relationship,socially differen
t ,age difference
4 23 18 registered 21yrs  –  Abuse
5 29 26 yes ? 2  – Homo sexual
6 22 39 no no  –  One 12yrs Older woman
7 46 42 no legal partners  – marriages 2+1 Extramarital unplanned
8 49 47 yes yes 3  – ? Menopause, late pregnancy
9 30 28 yes no 1  –  Contraception
10 25 24 yes no  –  – Contraception
11 30 28 yes no 1  – Son questioning, post
partum contraception
12           – 13 no no  –  – Puberty
13 19 15 no no  –  – Risky behaviour
14 62 57 yes no 4  – Pornography
       15             – 16 no ??multiple  –  –      Risky behaviour  












Free and informed decision making in relation to family planning has been known help couples to decide on what methods to use and to continue with the method that they have chosen. The client/ couple has to make a few fundamental decisions in relation to family planning – number of children they want, spacing or timing of pregnancies and the contraceptive options that are available to them to achieve the above. The client/ couple to make the correct decision they should have the following information on the method and support from the service provider –  mode of action, side effects, contraindications, when to discontinue, advantages, disadvantages, what to do if there is a side effect, when to come for follow up and where to go.


Elements of counselling would include –


Greet               – Make a good rapport with the client and maintain it

Ask                  – Ask questions to assess the situation

Tell                  – Tell the client about available options

Help                – Help the client choose a method

Explain                        – Explain every aspect of the selected method

Return                         – Care for the returned client for continued service


Types of questions to be asked during FP counselling –

To assess the need of FP:

No of children, space between children, age of the last child, difficulties in child rearing (social, medical problems)

Prefered number of children

Special interests to have boys or girls

Preferred time and next child

Social, demographic and economic background (age of the client, her spouse and the marriage, occupation, family income, etc)

Whether Breastfeeding

Previous FP method use – how long, what method, reasons for discontinuation if any,

To choose an appropriate method of contraception:

Menstrual history – LRMP, regularity, amount, inter menstrual spotting


Medical history – presence of illness – HT, DM, IHD, liver disease, malignancy, history of DVT, migraine, breast disease

Surgeries – previous and forthcoming

Use of drugs – anti epileptics, anti TB/ Leprosy and ART
















FP Case Studies:


Abortion – Who Should Decide & How

Abortion – The Child in the Womb Loves You & Knows You – Dr Lalith Mendis

Is the Foetus Protected by the Law of Persons or Property 

By the time your child in your womb is only 22 weeks she will not kick when you are asleep. She knows your sorrow & can recognise the last song you heard over the CD player. He already knows your heart beat. When you breast feed her, she will recognise that same heart beat. How can you think of destroying that child?  Legalising abortion for conception after statutory rape and for disabling congenital malformation seems a reasonable viewpoint for many. The issue is – who gives us authority to execute another person? Such execution and legalisation is unnecessary, since the “morning after pill” can effectively block conception after statutory rape. As the Sinhala proverb quips, “Why use an axe when a finger nail is adequate”.

The child in the womb from day one is another person. There is no way that a human conceived has to become more human as the pregnancy advances. Is the day one child in the womb, less human than the 20 week child? Is the 20 week child less human than the 40 week child? When mother claims rape will we legalise aborting the 39 week foetus?  If abortion for rape argument is valid, at any stage of pregnancy – even at 39 weeks child should be aborted. Then is infanticide of the new born (conceived after rape) also valid? If we approve abortion for the unborn because of congenital malformation, will that not validate infanticide for congenital malformation? What’s the logic that says murder in the womb is allowed and murder soon after birth is disallowed? What about those abortions over 24 weeks where the baby breathes on birth and is quickly strangulated? Or brain is damaged prior to delivery while the child is in the birth canal (euphemistically called cephalotomy) to prevent the embarrassment of the child breathing. All doctors know this is done. Alberto Giubilini of Monash University (Melbourne, Australia) and Francesca Minerva of the Oxford Uehiro Centre for Practical Ethics (UK), published a paper entitled, “After-birth abortion: why should the baby live?” And it was in the (grossly misnamed?) Journal of Medical Ethics. They argued that if abortion is OK, infanticide is also should be legitimized because the newborn is hardly human! If abortion is legalised abandonment of unwanted children will increase and murder of children congenitally deformed will happen.

Sociological Consequences of Legalising Abortion for Rape

  1. Teen pregnancies & sexual abuse of the under-aged will increase.
  2. Conservative contraceptive methods will be abandoned
  3. Infanticide will further increase – “if it is OK to kill the child in the womb why not kill the unwanted newborn” is how people already think.
  4. Any person wanting abortion will have a legal loophole
  5. Given our culture men will compel women to procure abortion rather than prevent conception
  6. We will be spilling more blood. Spilling of more innocent blood has moral consequences
  7. At present 90% of abortion is by married women


  1. Women who had abortions had experienced major depression within the last four years. That’s almost double the rate of women who never became pregnant
  2. Women who have abortions were twice as likely to drink alcohol at dangerous levels and three times as likely to be addicted to illegal drugs The risk of anxiety disorders also doubled
  3. Women who have abortions of unexpected pregnancies were 30 percent more likely to experience subsequent problems with anxiety than those who don’t have one.
  4. Women in the study who had abortions and suffered from general anxiety disorder experienced irritability, fatigue, difficulty sleeping, a pounding or racing heart, or feelings of unreality.
  5. Women having abortions face more than a doubled risk of future sterility
  6. Aborting women face a 50% increased risk of having a subsequent ectopic or tubal pregnancy. The risk was nearly twice as high (90%) for women having two or more previous abortions
  7. Decreased cervical resistance due to forced dilation may result in early cervical failure and the spontaneous abortion (miscarriage) of future pregnancies

Unwanted child” is the victim not of his own shortcomings but of those in a society attempting to solve its social, economic and personal problems by the sacrificial -offering of its children.

Concerned Professionals Forum –

Abortion ­ Who Should Decide and How?

Some argue that unplanned pregnancies incapacitate the woman and burdens society. The aged, the deformed and the mentally retarded burden the society. Should they too be eliminated? Should the depressed be provided with Kerkovan Euthanasia? What about infanticide for the unwanted newborn? When men begin to play God, some may decide that some races should be eliminated as Hitler did. The superpowers may think that some backward country should be their backyard for dumping nuclear waste.

Even desired and  planned  pregnancies incapacitate  the woman within and beyond the confinement. Abortions  are demanded for ‘unwanted’ pregnancies. Granting the abortion demand cannot  bring biological or social equality. If one views pregnancy and motherhood  as a social inequality created by nature, how will we go through desired and planned pregnancies? Has the mother got to be loaded with the  thought `oh  wretched me, I have to bear; not my husband’. No! We did not  think that way until depersonalization of 20th century man and moral relativism began to pervade our thinking. Thank God that the majority of Sri Lankan women do not think like that.


Secondly if men and women say, ‘we have a right over our body and wish to commit suicide’, will that too be granted?  Killing because the baby is unwanted will leave the door for the elimination of all kinds of unwanted persons. E.g. Old age, mentally retarded, some races.


Why was the Hippocratic oath liberalized? At a time when abortion was practiced secretively, Hippocrates thought it necessary to put his students on oath against it. Today the medical and legal professions are in the forefront of the pro-abortion debate. It is the common citizen who should decide on this, as it concerns all of society.


Hence the abortion – issue cannot be based on nature’s inequality – argument. A career woman or any other woman has only to plan her pregnancy and abortion cannot be a mode of contraception. Why have all societies initially been unwilling to legalize abortion and why did all cultures consider abortion undesirable and unethical? This is confirmed in the original Hippocratic oath in which the practitioner was required to say, ‘I will not aid a woman to procure abortion’.

What is not known by most is that many ancient civilizations had laws that proscribed abortion. An ancient Assyrian Law, dating between 1450 and 1250B.C.  recommended death sentence to those who procure abortion. (Middle Assyrian Law 53. Sumerian Laws 1-2, Lipit Islitar Laws III, 2-13, Code of Hammurapi 209-14, Hittite Law Code 17-18 similarly censured abortion). Among the Hebrews, the Bible laid down strict penalty for those who practiced abortion. Exodus 21:21-24.


Plato and Aristotle suggested that in their ideal societies abortion would be mandatory, chiefly to limit family size. Such thinking led to widespread abortions and also infanticide from exposure in the Greeco- Roman World. Even in such a context, Hippocrates clearly laid down a prohibition on abortion to his students. Hasting’s in his authoritative Encyclopaedia of Religions points out that, Christianity as it spread re-established the sanctity of the life of the unborn. Russia in 1920, legalized abortion for economic reasons. Roe Vs Wade decision in 1973 in the USA and UK abortion act of 1967, were completely against the flow of legal premises that obtained at that time. In both countries these landmark decisions have come under severe censure. We in Sri Lanka should be guided by our own premises of law making and not by erroneous precedent. Moral degradation of another country cannot be the basis of our lawmaking.


Right to the Body

Abortion must be viewed as an issue that concerns the very basis of life and society. Marriage was a social institution (a social contract) and not a private act. Sexual intercourse was meant to be a responsible contract within the MARITAL COVENANT. Two individuals by their free will initiate a new life, in the zygote. It has unique features, that neither father nor mother has.


Once fertilization has begun, one should know that he/she creates an irrevocable individuality. Neither (father nor mother) has the right to destroy the individuality. To create that new life is delegated authority from nature. There are many methods available to prevent fertilization. Once the unique potential life in the zygote is made by the will of two, who had socially contracted with the approval of society, then, no one individual should be allowed to destroy that life.


Abortion – think right!

Winds of Socio Political Change

  • Health of Woman after abortion
  • Fetal Pain
  • Sentience
  • Effect of IVF & Zygote destruction
  • Science & Sale of Fetal ATissue


Winds of Social Change

  • Original Oath of Hippocrates – “I will not help a woman to procure an abortion.
  • Changed in 1972
  • 1970 – Roe vs Wade decision in USA
  • 1967 – abortion legalised in UK
  • Abortion is illegal in Sri Lanka – but 1000 abortions a day in Colombo


Killing The Zygote

  • Destruction of excess zygotes after IVF
  • Destruction of Zygote at Pre-Implantation Genetic Diagnosis
  • Using zygotes for “Therapeutic cloning” to obtain Embryonic Stem Cells
  • Developing zygotes into fetuses in order to abort to obtain for fetal tissue for research

With the formation of the zygote a new life has begun. No one has authority to destroy that life.

Health of Woman

  • women who had abortions had experienced major depression within the last four years. That’s almost double the rate of women who never became pregnant
  • women who have abortions were twice as likely to drink alcohol at dangerous levels and three times as likely to be addicted to illegal drugs The risk of anxiety disorders also doubled
  • women who have abortions of unexpected pregnancies were 30 percent more likely to experience subsequent problems with anxiety than those who don’t have one.
  • Women in the study who had abortions and suffered from general anxiety disorder experienced irritability, fatigue, difficulty sleeping, a pounding or racing heart, or feelings of unreality.
  • Women having abortions face more than a doubled risk of future sterility
  • aborting women facing a 50% increased risk of having a subsequent ectopic or tubal pregnancy. The risk was nearly twice as high (90%) for women having two or more previous abortions
  • Decreased cervical resistance due to forced dilation may result in early cervical failure and the spontaneous

abortion (miscarriage) of future pregnancies


Increased Cancer Risk

Scientific Evidence of Abortion’s Impact

  • Thirteen out of 17 studies in the S. reported more breast cancer among women who chose abortion.36 A
  • 1996 meta-analysis of all published reports on the incidence of induced abortion and breast cancer appearing

in the Journal of Epidemiology and Community Health found, on average, a 30% increased risk.37

  • Link to Other Cancers
  • Abortion has also been associated with higher rates of cervical and ovarian cancer
  • Abortion & Breast Cancer
  • There is increasing evidence of the link between abortion and breast cancer… why aren’t women being told?
  • Professor Joel Brind has been researching this link between abortion and breast cancer for a long time.
  • His website documents the major research and studies: visit Coalition on Abortion/Breast Cancer
  • A recent major study also highlights the link – it was published by Patrick Carroll in the Journal of American Physicians and Surgeons, Volume 12, Number 3, Fall 2007.
    The Breast Cancer Epidemic: Modeling and Forecasts Based on Abortion and Other Risk Factors
  • His conclusion?
    “The increase in breast cancer incidence appears to be best explained by an increase in abortion rates, especially nulliparous abortions, and lower fertility.”


Welcome Changes

  • George Bush banned partial birth abortions in 2003 in the USA
  • Federal Funding for NGOO with abortion agenda in third world banned
  • Federal funding for embryonic stem cell research which kills abortions banned
  • This may have accelerated adult stem cell research producing over 70 successful cures


Unwelcome Changes

  • Obama in 2009 reverses Bush ban of federal funding for abortions & embryonic stem cell research
  • Efforts are underway to legalise partial birth abortion


Fetal Physiology

  • The first fetal movements are seen at seven weeks
  • over 20 different movement patterns have been described up to 16 weeks including hand-face contact, startle and sucking and swallowing movements
  • During the second trimester rest-activity cycles are observed
  • development of rapid eye movement (REM) periods starts at 23 weeks.
  • During the last three to four weeks complex and stable patterns of behaviour are apparent
  • Med Ethics 2001;27:ii15-ii20 doi:10.1136/jme.27.suppl_2.ii15 Medical paternalism and the fetus – John Wyatt University College, London


Fetal Development

  • first responds to sound at 20 weeks and subsequently develops more sophisticated auditory processing with the ability to discriminate different sounds.
  • Towards the end of pregnancy the mother’s voice can apparently be perceived clearly through the other sounds of the abdomen. Other responses include those to touch, changes in temperature and even the taste of the amniotic fluid.
  • From 25 weeks the fetus tries to maintain its position in space, as the mother moves around.
  • Complex cardiovascular and hormonal stress responses to invasive procedures have been detected from before 20 weeks gestation


Fetal Pain

  • As facial grimacing and aversive responses to
  • noxious stimuli can be seen in premature babies from before 26 weeks gestation, there seems to be prima facie evidence of a primitive form of awareness of pain in the fetus from this gestational age and possibly earlier.


Survival of PreTerm Infant

  • Survival at 23 and 24 weeks of gestation is now commonplace and occasional survival at 22 weeks and less than 500g birthweight has been described.
  • My own perspective, however, is that the current legal position in Britain, where late feticide can be performed, in theory, at any stage until the moment of delivery, is morally and practically unsustainable. It is remarkable that the current legal position has aroused such little public interest and debate. Surely these are issues which deserve wider discussion and debate.


Dr Anand on fetal pain

  • Dr Kanwaljeet Anand, an expert in Pediatric Critical Care Medicine and Anesthesiology, In 2005, he testified before Congress that a fetus as early as 20 weeks would experience abortion as “painful, unpleasant, noxious stimulation.” He argues that while the brain is still developing, the fetus receives pain signals in the subcortex.
  • ablation or stimulation of the sensory cortex does not alter adult pain perception, whereas thalamic ablation or stimulation does. The foetal thalamus develops in the second trimester, well before the cortex. If the sensory cortex is not essential for adult pain, why is foetal pain held to that standard?
  • Fully functioning sensory receptors appear in the skin around the mouth of the fetus at 7 weeks and spread to all skin and mucous surfaces before 20 weeks of gestation. Nerve fibers precede the appearance of these skin receptors and are capable of transmitting sensory stimuli from the periphery to the spinal cord at all times. For entire report by Dr. Kanwaljeet Anand


  • Highest Pain Receptor Density Before Birth
  • Between weeks 20 and 30, an unborn child has more pain receptors per square inch than at any other time, before or
  • after birth, with only a very thin layer of skin for protection.
  • Pain Inhibition Not Fully Developed Until Later
  • Mechanisms that inhibit or moderate the experience of pain do not begin to develop until weeks 30-32. Any pain the unborn child experiences before these mechanisms form is likely worse than the pain an older child or adult experiences

The neural pathways are present for pain to be experienced quite early by unborn babies.
  – Steven Calvin, Perinatologist, University of Minnesota
“At 20 weeks, the fetal brain has the full complement of brain cells present in adulthood, ready and waiting to receive pain signals from the body, and their electrical activity can be be recorded by standard electroencephalography (EEG)” – Dr. Paul Ranalli, neurologist, University of Toronto

Scientific evidence suggests abortion is excruciatingly painful for the unborn child.

An unborn child at 20 weeks gestation “is fully capable of experiencing pain… Without question, [abortion]is a dreadfully painful experience for any infant subjected to such a surgical procedure.    – Robert J. White, MD., Ph.D. professor of neurosurgery, Case Western R eserve University


Fetus 18 days – – Brain

  • The brain begins to take shape
  • only 18 days after conception. By
  • 20 days, the brain has already
  • differentiated into forebrain,
  • midbrain, and hind brain, and the
  • spinal cord has started to
  • (1)


Fetus 5 weeks Pain Receptors

  • Four or five weeks after
  • conception, pain receptors appear
  • around the mouth, followed by
  • nerve fibers, which carry stimuli
  • to the brain. By 18 weeks, pain
  • receptors have appeared
  • throughout the body. Around
  • week 6, the unborn child first
  • responds to touch.(2, 3)


Fetus 6 weeks – Cortex

  • In weeks 6-18, the cerebral cortex
  • By 18 weeks the cortex
  • has a full complement of neurons.
  • In adults, the cortex has been
  • recognized as the center of pain
  • (3)


Fetus 8 weeks – Thalamus

  • During weeks 8-16, the
  • thalamus develop s, functioning as
  • the main relay center in the brain
  • for sensory impulses going from
  • the spinal cord to the cortex.(1)



Fetus 14-18 weeks – 14-18 Wks – Nerve Tracts

  • In week 18, nerve tracts
  • connecting the spinal cord and the
  • thalamus are established, and
  • nerves from the thalamus first
  • contact the cortex in week 20.
  • Nerve fibers not routed through
  • the thalamus have already reached
  • the cortex by 14 weeks. (3,4)

Fetus 18 weeks – 18 Wks – Stress Hormones

  • As early as 18 weeks, stress
  • hormones are released by an unborn
  • child injected by a needle, just as they
  • are when adults feel pain. Hormone
  • levels in those babies decrease as
  • pain-relievers are supplied.(7)


Fetus Pain – Before 18 Weeks?

  • Even before nerve tract s are
  • fully established, the unborn child
  • may feel pain; studies show
  • anencephalic infants, whose cortex
  • is severely reduced if not altogether
  • missing, may experience pain as
  • long as other neurological
  • structures are functioning


Genetic Counseling for Disabilities
Over one third of a sample of obstetricians in England and Wales said that they generally require a woman to agree to terminate an affected pregnancy before proceeding with prenatal diagnosis.8 Several studies have shown that different ways of presenting risks of genetic disease result in different choices by parents.10 Similarly the identity of the person who provides counselling (obstetrician, geneticist, paediatrician, independent counsellor) seems to change the likelihood of opting for abortion.

Cow Human Embryos
in the United Kingdom cow ova (eggs) have been impregnated with human sperm (where thus far the ‘pregnancy’ is terminated before it gets beyond the two-cell stage). In the United States, 20,000 cow-human embryos are created each month, supposedly for testing male fertility.*

Dr J. Densen-Gerber, a speaker at the conference who has been asked by 11 American States to draft legislation in this area, and who hardly qualifies as the lunatic fringe, was quoted as saying: ‘If you don’t think there are Frankensteins sitting in the world’s laboratories playing God, I think you don’t really understand what’s going on.’


In Rethinking Life and Death, Singer takes the view that ‘newborn-infants, especially if unwanted, are not yet full members of the moral community’, and proposes a 28-day period in which the infant might be killed before being granted full human rights.



Unchartered Mayhem – Twenties to Thirties

Unchartered Mayhem – Twenties to Thirties

New York Times – David Brook

A few months ago I had lunch with a former student named Lucy Fleming, one of the best writers I’ve taught. I asked her what she had learned in her first year out of college. She said she had been forced to think differently.

While in school, her thinking was station to station: take that test, apply to that college, aim for a degree. But in young adulthood, there are no more stations. Everything is open seas. Your main problems are not about the assignment right in front of you; they are about the horizon far away. What should you be steering toward? It requires an entirely different set of navigational skills.

This gets at one of the oddest phenomena of modern life. Childhood is more structured than it has ever been. But then the great engine of the meritocracy spits people out into a young adulthood that is less structured than it has ever been.

There used to be certain milestones that young adults were directed toward by age 27: leaving home, becoming financially independent, getting married, buying a house, having a child. But the information economy has scrambled those timetables. Current 20-somethings are much less likely to do any of those things by 30. They are less likely to be anchored in a political party, church or some other creedal community.

When I graduated from college there was a finite number of career ladders in front of me: teacher, lawyer, doctor, business. Now college graduates enter a world with four million footstools. There are many more places to perch (a start-up, an NGO, a coffee shop, a consultancy) but few of the footstools pay a sustaining wage, seem connected with the others or lead to a clear ladder of rungs to climb upward.

People in their 20s seem to be compelled to bounce around more, popping up here and there, quantumlike, with different jobs, living arrangements and partners while hoping that all these diverse experiences magically add up to something.

Naturally enough, their descriptions of their lives are rife with uncertainty and anxiety. Many young adults describe a familiar pattern. They try something out but soon feel trapped. They drink too much, worry about how to get out of a job or a relationship. Eventually they do, which is often easier than the anxiety beforehand. They put their life on pause, which is lonely, while they re-cohere. Then they try something else.

All the while social media makes the comparison game more intrusive than ever, and nearly everybody feels as if he or she is falling behind. Recently I came across a website with popular message tattoos. The ones people chose weren’t exactly about carefree youth. They were about endurance and resilience: “I will break but I will not fold”; “Fall down seven times, stand up eight”; “Don’t lose yourself in your fear”; “The only way out is through.”

And how do we as a society prepare young people for this uncertain phase? We pump them full of vapid but haunting praise about how talented they are and how their future is limitless. Then we send them (the most privileged of them) to colleges where the professors teach about what interests the professors. Then we preach a gospel of autonomy that says all the answers to the deeper questions in life are found by getting in touch with your “true self,” whatever the heck that is.

I used to think that the answer to the traumas of the 20s was patience. Life is long. Wait until they’re 30. They’ll figure it out. Now I think that laissez-faire attitude trivializes the experiences of young adulthood and condescends to the people going through them.

I’m beginning to side with Meg Jay, who argued in her book “The Defining Decade” that telling people “30 is the new 20” is completely counterproductive.

Jay’s book is filled with advice on how to get on with life. For example, build identity capital. If you are going to be underemployed, do it in a way that people are going to find interesting later on. Nobody is ever going to ask you, “What was it like being a nanny?” They will ask you, “What was it like leading excursions of Outward Bound?”

I’d say colleges have to do much more to put certain questions on the table, to help students grapple with the coming decade of uncertainty: What does it mean to be an adult today? What are seven or 10 ways people have found purpose in life? How big should I dream or how realistic should I be? What are the criteria we should think about before shacking up? What is the cure for sadness? What do I want and what is truly worth wanting?

Before, there were social structures that could guide young adults as they gradually figured out the big questions of life. Now, those structures are gone. Young people are confronted by the existential questions right away. They’re going to feel lost if they have no sense of what they’re pointing toward, if they have no vision of the holy grails on the distant shore.


Drug Conspiracy against Children


According to NAMI (National Alliance on Mental Illness), “More than 25 percent of college students have been diagnosed or treated by a professional for a mental health condition within the past year.”

NAMI: “One in four young adults between the ages of 18 and 24 have [we claim] a diagnosable mental illness.”

According to, 6.4 million American children between the ages of 4 and 17 have been diagnosed with ADHD. The average age for the child’s diagnosis is 7.

BMJ 2016;352:i1457: “The number of UK children and adolescents treated with antidepressants rose by over 50% from 2005 to 2012, a study of five Western countries published in European Neuropsychopharmacology has found.”

Ritalin & ADHD

Let’s look at just one of the drugs: Ritalin (or any similar ADHD medicine). After a creative child is seen fidgeting in class, looking bored, studying what he wants to study, ignoring classroom assignments, focusing on what interests him, he is diagnosed with ADHD. Then comes the drug.

In 1986, The International Journal of the Addictions published an important literature review by Richard Scarnati. It was called “An Outline of Hazardous Side Effects of Ritalin (Methylphenidate)” [v.21(7), pp. 837-841].

Scarnati listed a large number of adverse effects of Ritalin and cited published journal articles which reported each of these symptoms.

For every one of the following (selected and quoted verbatim) Ritalin effects, there is at least one confirming source in the medical literature:

* Paranoid delusions
* Paranoid psychosis
* Hypomanic and manic symptoms, amphetamine-like psychosis
* Activation of psychotic symptoms
* Toxic psychosis
* Visual hallucinations
* Auditory hallucinations
* Can surpass LSD in producing bizarre experiences
* Effects pathological thought processes
* Extreme withdrawal
* Terrified affect
* Started screaming
* Aggressiveness
* Insomnia
* Since Ritalin is considered an amphetamine-type drug, expect amphetamine-like effects
* Psychic dependence
* High-abuse potential DEA Schedule II Drug
* Decreased REM sleep
* When used with antidepressants one may see dangerous reactions including hypertension, seizures and hypothermia
* Convulsions
* Brain damage may be seen with amphetamine abuse.

Under this chemical assault on the brain, what are the chances that a creative child will go on in life to become an innovator, rather than a victim of psychiatric drugging?

Make a list of your favorite innovators. Imagine them as bored distracted children sitting in classrooms…and then diagnosed, and then hammered with drugs prescribed by a doctor.

This is happening now.

Anti Depressants

Here is just a sprinkling of information about antidepressants, from a huge body of literature:

Psychiatrist Peter Breggin: February 1990 American Journal of Psychiatry (Teicher et al, v.147:207-210) reports on “six depressed patients, previously free of recent suicidal ideation, who developed `intense, violent suicidal preoccupations after 2-7 weeks of fluoxetine [Prozac] treatment.’ The suicidal preoccupations lasted from three days to three months after termination of the treatment. The report estimates that 3.5 percent of Prozac users were at risk. While denying the validity of the study, Dista Products, a division of Eli Lilly, put out a brochure for doctors dated August 31, 1990, stating that it was adding `suicidal ideation’ to the adverse events section of its Prozac product information.”

An earlier study, from the September 1989 Journal of Clinical Psychiatry, by Joseph Lipiniski, Jr., indicates that in five examined cases people on Prozac developed what is called akathesia. Symptoms include intense anxiety, inability to sleep, the “jerking of extremities,” and “bicycling in bed or just turning around and around.” Dr. Peter Breggin comments that akathesia “may also contribute to the drug’s tendency to cause self-destructive or violent tendencies … Akathesia can become the equivalent of biochemical torture and could possibly tip someone over the edge into self-destructive or violent behavior … The June 1990 Health Newsletter, produced by the Public Citizen Research Group, reports, ‘Akathesia, or symptoms of restlessness, constant pacing, and purposeless movements of the feet and legs, may occur in 10-25 percent of patients on Prozac.’”

The well-known publication, California Lawyer, in a December 1998 article called “Protecting Prozac,” details some of the suspect maneuvers of Eli Lilly in its handling of suits against Prozac. California Lawyer also mentions other highly qualified critics of the drug: “David Healy, MD, an internationally renowned psychopharmacologist, has stated in sworn deposition that `contrary to Lilly’s view, there is a plausible cause-and-effect relationship between Prozac’ and suicidal-homicidal events. An epidemiological study published in 1995 by the British Medical Journal also links Prozac to increased suicide risk.”

When pressed, proponents of these SSRI antidepressant drugs (Prozac, Zoloft, Paxil, etc.) sometimes say, “Well, the benefits for the general population far outweigh the risk.” But the issue of benefits will not go away on that basis. A shocking review-study published in The Journal of Nervous and Mental Diseases (1996, v.184, no.2), written by Rhoda L. Fisher and Seymour Fisher, called “Antidepressants for Children,” concludes: “Despite unanimous literature of double-blind studies indicating that antidepressants are no more effective than placebos in treating depression in children and adolescents, such medications continue to be in wide use.”


Prophecy for Nation’s President

Prophecy for President Premadasa. (given when we met him on 15.3.92)

We prayed over the President. During the days that followed, the President appeared subdued. He lamented that he was wrongly suspected for the assassination of a political opponent. It was a time when no one’s life was safe. Many paramilitary groups were operating to crush the Marxist militancy. The Tiger terrorists too were planning his assassination. The President died on the spot on the first of May of 1992, when a suicide bomber exploded himself while the President was watching a political procession.

When I delivered the prophecy with my finger pointing at him – I apologized & said “forgive me but I speak from an authority from above”. He said, “I believe that because when I was impeached, I heard a voice from above saying – Prorogue. That’s what I did to Parliament”.

Prophecy –

“My power is available to you, I am holy therefore my power is holy. My power can only work through a holy channel! I shall not share my glory with another. All power belongs to me. If you want my power to work for you, you must choose my power alone. I will not share my glory with another power. Vengeance is mine to punish the wicked and you too must punish only the wicked. You are my servant and you bear my sword and authority, you cannot misuse it, vengeance is mine. I will repay and protect my power and glory with jealous wrath; to acquit the guilty is wickedness, to punish the innocent is wickedness, I am the Law giver I give my Laws to the universe. I give my Laws to the human society, I am the Judge. I judge according to my holy Laws.

Blessed is the nation that has the living God as their God. It is great wickedness to give anyone else glory or honour due only to the living God, because I am the heavenly majesty, I am your master. You are my servant. A servant can rule only be the power and authority of the master. If you have my power you will do well. If you do not have my power you will be weak. Seek no other beside my power. If you call unto me I will answer you. There is no plan or wisdom that will succeed against the Lord; as long as I uphold you no power on earth or under the earth can put you down, I am the Lord thy God, there is none beside me. All the ends of the earth shall look to me and be saved. When a King desires good for his people and call upon me I will do that good, even if the people be wicked if the king sets his heart to seek me. I will do good to the people because of the righteousness of the king. Righteousness comes from me. I love righteousness for my namesake I will lead you in the paths of righteousness. Put your trust in me. Do not put your trust in man whose breath is in his nostrils. He is here today and gone tomorrow. I Live forevermore. I know the future. The future is in my hands; the destiny of a nation or a ruler is in my hands. So fear me; do not fear gods that are no gods. If you fear me you will be delivered from all other fears. My power will protect you.”

I am your Father. You are My son – by virtue of your Office I have to treat you as My son. You can call on Me – I will answer.

I am Your Saviour. If I do not save you, you will want to take vengeance. Vengeance is Mine.

I am the Great Shepherd. You are My under-shepherd. I share My office with you as the Shepherd of the people. By My God pleasure you will shepherd the people I give you. I will give you skillfulness of hand & integrity of heart.