Eighteen-year-old Smita Karani* sits at the edge of the toilet seat, watching in horror as two purple lines slowly emerge, becoming darker and darker, until even the most hopeful thought is replaced with despair and fear. There is no doubt about it -- the home pregnancy kit confirms that she is pregnant.

Whether you're 20 years old or 40, married or unmarried, rich or poor, an unplanned pregnancy can turn your life upside down and throw all your carefully laid plans out the window. Indian society, while frowning upon pre-marital sex and unwed mothers, has made provisions for a woman to save face and escape accusing glances in this situation. So if you find yourself pregnant, don't panic until you've considered your options.

Broadly, you have three choices:

Abortion

Of the three choices, abortion is the most common in India. The stigma and shame attached to being an unwed mother is too great to allow for much else. If you decide to get an abortion, you can, upto five weeks, choose between a medical abortion (pills) and a surgical one. Do remember to call a hospital/ clinic and enquire whether they perform abortions there, as some hospitals (like Lilavati in Bandra, Mumbai) don't.

A medical abortion is conducted with the use of abortion pills. This is a three-day course and the abortion takes place on the third day. These pills should NOT be taken without prescription and supervision of a gynaecologist. Taking them without proper supervision could lead to unprecedented bleeding and further complications. Unfortunately, they are available over the counter in India, which is a rather dangerous thing. Also, you will need to go for an ultrasound and follow up about two weeks after the abortion to make sure the procedure was successful.

After five weeks, however, a surgical procedure is your only option. If you opt for a surgical abortion, you will need to give your gynaecologist a couple of days to make arrangements at the hospital/ clinic. The actual procedure takes only about 15-20 minutes, but you will have to stay in the hospital for four to five hours.

Both options are extremely safe and have high success rates. Dr Ranjana V Dhanu, a practicing gynaecologist in Mumbai, says, "One sees increased promiscuity among young people these days. Also, their knowledge about contraceptives is inadequate, which leads to these unfortunate accidental pregnancies. However, getting an abortion is quite easy and hassle-free."

Dr Sunil Dalvi, a Mumbai-based physician feels that due to education and emancipation, patients these days are able to deal with the situation. He says, "Young girls are not too scared to come in for the procedure anymore. The facade of boldness is always there. Also, I see middle class families taking it much better and supporting the girls. The concept of girls being inferior to boys, or of them being "damaged goods" because of an abortion does not exist, at least in Western India. In fact, men might be idiotic and hypocritical in that way, harping on about family honour and chastity, but the female relatives of the girl often stand by her."

Whatever you choose to do, make absolutely sure that the abortion is conducted under the supervision of a trained gynaecologist in a reputed clinic/ hospital. A medical abortion costs about Rs 2,000 to Rs 3,000, while a surgical one can cost anything between Rs 2,000 to Rs 30,000. A hospital or abortion clinic would be your best bet, but don't compromise on the qualifications of your gynaecologist or the reputation of the clinic/ hospital just to save a few bucks.

The consequences of an unsafe abortion could range from haemorrhage to infertility to death. "In rural areas, young girls sometimes find themselves in the hands of quacks who pass sticks into their uterus, causing incomplete abortions, infertility and in extreme cases, even death," cautions Dr Dhanu.

Post-abortion care is very important to ensure no long-term effects. It is recommended that you stay in regular touch with your gynaecologist for a month after the procedure, keeping him/ her in the loop regarding all developments concerning the abortion. Here is a general list of dos and dont's:

Abortions and emotional turmoil

Having an avalanche of fears, questions and feelings envelope you while considering an abortion is perfectly normal. Dr Rekha [Images] Agrawal, a Mumbai-based consulting gynaecologist explains, "It is common for young girls to be full of nervous questions when they visit. I see about seven to eight such cases every month. They may not be too young, but they are concerned about the same things -- whether anyone will find out, if future pregnancies will be affected, how much time they will have to spend in the hospital etc. Having got themselves into a pickle, they are all ears about contraception methods to ensure this never happens again."

This is a stressful event in a woman's life and many couples have been known to break up over feelings of guilt, resentment and blame following an abortion. The emotional after-effects are far more severe than any physical aspect of undergoing an abortion and few women come out of the experience unchanged. It is important that the trauma be dealt with appropriately, else it could lead to long-term mental and psychological effects that might hamper future pregnancies and relationships. Dr Dalvi says, "Though boldness and practicality among young girls has increased, I have not seen a single one go through the experience without feeling guilt and stress. At the end of the day, a woman is a woman."

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Anamika Sinha*, a student from Delhi [Images] shares her story. "I had an abortion two years ago. I was 22 years old and should have been more careful, but we always thought nothing that scary could happen to us. My boyfriend and I were terrified when we found out. I kept thinking about how happy my family would have been if I had been expecting this baby after my marriage. Then there was this heart wrenching feeling of guilt -- of what a terrible mother I was, to consider killing my own baby, who was a part of me. I also felt very scared about the longterm effects, since I didn't know anything about abortions. But then what choice did we have? We certainly couldn't have the baby and couldn't even take anyone apart from a few close friends into confidence.

"At the end, my boyfriend and I went under assumed names to a hospital close by and spoke to a gynaecologist. We only relaxed a little when we were assured that nobody would find out and that not even another gynaecologist would be able to tell that I had had an abortion. I decided to go for a surgical abortion, which was conducted after using general anaesthesia. Though I didn't feel any physical pain to speak of, the emotional oscillations were almost too much to bear. I found myself crying for days afterwards. I also had feelings of anger and helplessness -- I didn't know how to make myself feel better."

Dr D K Deshmukh, a Mumbai-based consultant psychiatrist says, "Counselling is not as widely accepted in India as the West. Couple it with the stigma of an abortion, and we find a very small percentage of girls choosing to receive counselling. We mostly see them only when they have developed extreme issues of depression, anxiety and guilt. The trauma becomes a nucleus that often causes stress and complications in future pregnancies and relationships."

Dr Deshmukh strongly recommends counseling for women who have gone through an abortion and believes that couple therapy also works in keeping the relationship intact through this difficult time. Often, men don't realise their role in the event and their right to grieve for their loss. Since the responsibility of a decision like this lies with both partners, it is important for the man to be sensitive to the emotional upheavals his partner is going through and at the same time, be able to express his own feelings to her. This can be an emotionally draining responsibility, which is where counselling comes in and provides the glue required to keep the couple together.

"After the abortion, my boyfriend and I went through a very rough patch. I was hurting and didn't know how to let it out, so I lashed out at him. He, on the other hand, was depressed all the time, and refused to talk to me. We were unable to share each other's pain and offer comfort. I think counselling would have been a big help to us at the time," explains Anamika.

While this article is in no way a substitute for a counsellor, here are some dos and don'ts for the partner of a woman who has undergone an abortion:

• Be gentle, supportive, patient and understanding of your partner's emotions.
• Allow her to talk and express her feelings.
• Talk to her and express your feelings.
• Opt for counselling and encourage her to join you.
• Don't blame her for her decision to abort.
• Don't impose your views (religious or otherwise) regarding the abortion on her.
• Don't stop yourself from grieving for your loss.

Adoption

Although abortion is a convenient method to end an unwanted pregnancy, it is not everyone's cup of tea. Some oppose it on the basis of religious views, while others feel an induced miscarriage is equivalent to murder or is just plain unnatural. If you feel this way, then adoption might be your best bet, although carrying the baby to term might land you in a quandary if you are very young. It has been seen that there are physical complications, like increased chances of C-sections in pregnant teenagers. Dr Ranjana Dhanu, Mumbai-based gynecologist says, "There is an increased chance of maternal morbidity and mortality in younger girls. Their bodies are not developed enough to bear a child."

However, if none of these issues apply to your situation, and you intend to give birth, the first thing you need to do is identify where you would like to give birth. If you choose a hospital, be aware that the baby will be registered in your name, which might pose a problem if anonymity is your priority.

There are institutions that run homes for unwed mothers and women of lesser means that preserve complete confidentiality and retain the child in orphanages, helping in the adoption process. Sister Helen Gonsalves of St Catherine's Home, which is one such institution in Mumbai says, "Many young pregnant girls come to us and we take care of them from the time they come to the time of their delivery. We provide free medical care, free board and lodging and free counselling. We also teach them vocational activities like stitching and about childcare, in the hope that they might change their minds and decide to keep the child."

Since hospitals are public places, there is always the fear that you might run into someone you know, or that someone might be able to access your records. However, in institutions like St Catherine's Home, confidentiality is a priority. Explains Sister Helen, "For these girls, anonymity is of primary importance. They are sometimes wary of hospitals because they feel someone may find out about their situation. Then they come to us and we take care of them, providing them with everything they need."

You can find a list of orphanages in your city by looking them up on the Internet. Most orphanages are listed online, along with addresses, phone numbers and other contact details.

Psychological effects of giving a child up for adoption

To give your child up for adoption, all you have to do is sign a Document of Surrender that states you are willingly surrendering your child to the care of the home. St Catherine's Home also allows mothers to come back and claim their children within two months of leaving them there. After which, the child is put up for adoption and the birthmother has no right over it. Though the mothers form a bond with their babies, most feel compelled to give up their children due to societal pressure and stigma. This is a painful decision, and mothers-to-be should be absolutely sure of the implications and consequences of taking this step before they go ahead with it.

Counselling is a must afterwards, since the trauma of having given up a child after bearing it for nine months is something that could take years to get past. Family members of the girl must ensure she receives adequate professional help to deal with her loss. In some cases, it is useful for the family to go for counselling together, in order to facilitate the grieving process and help the girl to move on with her life. In the absence of help, the mother could develop serious long-term mental and psychological issues of depression and guilt, and might even have trouble sustaining a future relationship.

However, if neither abortion nor adoption suits you, your only choice would be to have the child and raise it. If you are very young, you might want to think this through with the help of a trusted adult or a psychiatrist. The younger you are, the higher the chances that you might not be physically, mentally, financially and emotionally ready to make a commitment as large as this. In this case, having the child might not be the wisest decision. However, if none of these issues apply to your situation, and your only concern is societal pressure, you could consider migrating. Dr Dalvi has seen some such cases. He says, "I have seen at least three such cases. Some of these girls very bravely decide to have the child and migrate abroad to raise it as a single parent. It is much easier in a foreign country where acceptance levels for such things are higher."

Whatever your final decision, realise that it will be one of the more important ones you make in your life, so do weigh all the pros and cons very carefully before you arrive at it. These choices are irreversible and can be life altering, so don't do anything in a hurry.

Above all, ensure that the decision is really yours, and not something you're being pressurised into.

*Names changed to protect privacy.