|| POST ABORTION TRAUMA HEALING SERVICE
Breaking the silence - information, hope and healing after abortion
Newsletter Excerpts 2012
Choice of Words
If it’s not a baby then you are not pregnant is a phrase that has been coined in pro-life circles,
and it is one that raises some interesting questions about the language we use
around pregnancy and abortion or termination.
The royal couple William and Kathryn are expecting their first baby. Being a much wanted child means all efforts are made to support the pregnancy and ensure the wellbeing of the mother. No-one has trouble saying that they are having a baby, and even the media support the concept.
Women who experience pregnancy-baby losses such as miscarriage or stillbirth, also naturally speak about losing their babies. For many there is a profound attachment from a very early stage to their developing offspring and so when they experience the loss of their little one, they grieve. Grief is personal and unique and some will grieve more than others for a whole host of reasons. In any event not just the pregnancy but the baby albeit small or unborn, was significant in some way and that makes the sense of loss real.
The arguments surrounding abortion have gone from whether life begins at conception, which is now scientifically proven to be so, to when does that life become a “person” in terms of a human being with rights. Once we think and speak in these terms the personal experience and relationship of pregnancy becomes lost in a sea of words that somehow tries to change the reality of what is there and what happens in abortion or termination in human terms.
For eons it has been accepted that once pregnant you were expecting a child, that you were growing a baby in your womb. Today depending on if your baby is planned and wanted or not the language surrounding the pregnancy can vary according to the situation.
Normally, if you plan and want your child then it is acceptable to talk about “my baby”… if not then “my baby” is spoken about, particularly within the health services, in terms of the pregnancy, products of conception, conceptus, gestational sac, embryo, foetus, pregnancy tissue and such like. These are all biological and medicalised terms which distance the mother from the relational reality of the pregnancy.
Attitudes to what is present in the womb (the uterus), and its value in terms of its size or whether it is wanted or not play a huge part in framing up the experience of the pregnancy and can contribute greatly to the outcome. The way pregnancy or termination of pregnancy is spoken about and framed up can also alter adjustment and the effects after termination, for some making it more positive but for others not.
For those who come to us for help after abortion and termination, the way they frame up their experience afterwards often does not match how they, and others, thought and spoke about it beforehand. How it seemed then is different from how they view and feel about it now. It is evident in the words used to describe the “then” experience and the “now” experience.
In the healing work post abortion or termination, the woman naturally is challenged. The head-heart disconnect that occurred at the time of the decision-making may itself be broken, and /or the reasoning that seemed sound at the time of the decision may no longer seem valid or acceptable. This can throw her into crisis as feelings surface and she is confronted with what has happened. This is this important to understand for those working with women making pregnancy-termination decisions or working in the termination area.
Attempts to ease distress by using medical or minimising language at the time people are considering abortion or termination, whilst helpful in supporting a woman through the termination process, can later become for some the cause of significant hurt.
Choice of words (her own, others’ in the family or wider circle or within the health services) play a part in influencing the expectant mother’s thinking and decision making around pregnancy and termination. If the reality of the pregnancy and termination spoken of with disregard for the relational and experiential aspects at the time of decision making then it can also serve to compound impacts and adjustment afterwards.
- Carolina Gnad
Lawful Acceptance or Practical Promotion
Defence for abortion has become so strong in society that it unfortunately disenfranchises
those for whom the termination was not a positive experience.
Decision-making processes may have been undermined
and attempts to address their feelings and issues is often viewed as a threat to the status quo.
The legal defence for abortion in New Zealand was the product of the long hard fight won historically by part of the feminist movement, and has meant that pregnancy termination has become a core health service. The ordeals of the past are hardly remembered by the majority of people in our communities. The effective promotion of pregnancy termination as a simple procedure in early stages, or medically recommended procedure for difficult pregnancies has seen it become more widely accepted and normalised in society. It appears to have become a streamlined service, but some report afterwards that when making their decision that they felt caught up in the process with little time, and sometimes support, to process what was happening, explore pressures and influences, and work through deeper feelings and needs, or fully understand the implications of their choice. Counselling is available but for many they are not in a space to have it and are not always encouraged to fully explore their options. Attitudes and actions of staff through the process affects decision-making and outcomes.
Encountering those who are strongly pro-abortion and those strongly pro-life in the course of my work, shows me that the longstanding battle still rages strong. Caught in the middle are health professionals trying to work with care and moderation, women and families confronted with huge dilemmas and babies (human embryos and foetuses) whose outcome is to be decided. It is stressful, confusing, conflicting, and at times crushing for those involved.
I have met good people on both sides, well intentioned, sincere and caring individuals, all grappling with the issues and attempting to do what they believe is right and best. Still there is no real meeting of the ways. Our seminars are attempts to try to bridge the gap and open up dialogue amongst people in the community and in health and welfare circles and create safe places to explore the experiences of those who work in and those who avail themselves of abortion or termination services, to get beyond the differences and better address issues of mutual concern.
I hear from people in the abortion and termination services seeking to improve their processes, wanting to ensure people are making more informed decisions around termination and who do not simply accept or promote abortion or termination as “the answer” to an unplanned or unwanted pregnancy. I have met women for whom medical reasoning for termination is not enough or not the whole answer, and who are pro-choice and interested in looking at other options as well. When we talk of choice we are meaning a decision that is made with free will, full information and an absence of pressure or coercion. And a decision made from a place of NOT
The resounding message from our post abortion clients, is that there is a need to enable more real choice and to do that we need to be slowing decision-making processes down and encouraging people to take time to reflect on relevant information and fully explore options in a more therapeutic way, taking into account deeper realities and both the potential short and long term implications. The pressures for many clients were huge and not always fully addressed. And although one of the pressures is time, there still needs to be a way to slow things down and not assume anything. One counsellor at a recent seminar said, that with her pregnant clients in coming to a decision, she would walk them through the options quite literally. They would literally walk through what each path could mean over time, not just in practical terms but also in relation to her self, her relationships, her values, her culture, dreams and plans. Counselling styles that are problem solving by nature may support the reasoning for or against abortion or termination with a client but not fully explore practical, emotional, relational and moral conflicts or resolve the client’s ambivalence. It may make it easier to go ahead with the abortion or termination, and they may feel good about the decision at the time, but for some it may be a disservice. More may have needed to be done around working with the ambivalence and through the various conflicts. Numbers of women who come to us afterwards and talk about their ambivalence at the time indicate that the issue of ambivalence was huge, not always recognised and not well worked through, sometimes because of lack of time and resources and sometimes because staff view abortion as a good thing.
If one is pro-abortion in one’s views one might be at risk of merely finding ways to support the person to have the abortion by reframing or making it easy for her to proceed. If one is extremely pro-life one might push for all the good reasons to continue that pregnancy and focus just on the negative aspects of terminating. How can one comply with legal requirements and support the client’s process to come to a fully informed decision? Are we open and as supportive of other options, giving them as much validity and weight in the process as the abortion or termination option? How staff think and act around the decision-making processes can affect the way clients understand or anticipate their post abortion or termination reactions, which may or may not eventuate.
A couple of questions to leave you with. “Is or was the pregnant person you know or are working with making an abortion decision or pregnancy choice? Are we engaging is a process around deciding to terminate or not, or making a pregnancy choice by exploring every option thoroughly.” “In our society and within abortion or termination services are we supporting lawful acceptance or practical promotion of abortion or termination? And how does this alter the way women engage in their decision-making and the flow on effect in post abortion or termination experiences?”
It would be interesting to create forums to discuss such questions. There would need to be an inordinate amount of good will, and would only be possible where people are not in fixed positions set to defend their position, but are interested in engaging and exploring differences openly and looking at different perspectives. This should be possible if we all have the interests and welfare of women and families and children at heart.
- Carolina Gnad
Helping Those Affected By AbortionThere is a real challenge for health professionals, and people in the community, to respond appropriately to people who may be experiencing difficulties following an abortion or termination of pregnancy, regardless of stage or circumstances. More so because the person affected may not be consciously aware of the changes in themselves from the experience. Regardless, our making assumptions, sharing our beliefs or wielding our truth, making judgments or giving advice.... can be met with a hurt or defensive reaction. The post abortive parent or someone who has made a difficult decision to terminate a pregnancy is particularly sensitive to the reactions of others around them.
No-one knows what they might do in the same situation for we cannot know for certain, until faced with such a dilemma. And no-one knows how they might react afterwards unless or until they have been there.
There is a need to challenge the taboo talking about abortion if we are to help people discover what the event may have meant for those involved. Many women, and men, with an abortion or termination experience, build protective walls around their hearts, to enable them to function and move beyond their experiences. It can be particularly difficult when they are confronted by people who either judge or are dismissive, and who fail to understand the complexity of things they faced and the depth of pain they may now carry.
Abortion or pregnancy termination has become a fact of life whether we like it or not. For those who avail themselves of the medical or surgical procedure that procures the termination of the pregnancy and the destruction of the developing human life that is their offspring, reactions are often mixed and unanticipated, confusing and hard to deal with. Initial relief may give way to sadness, loss of vitality, problems in relationship, feelings of regret or issues with guilt, spiritual alienation, depression, anxiety and a host of other possible symptoms of dis-ease because the perceived losses and felt trauma, attendant conflicts and the individual’s sense of responsibility.
So, when talking with someone you meet or know who has had an abortion or pregnancy termination be mindful or what you say and how you say it.
Don’t shut them off by changing the subject. Don’t condemn them for their choice. Don’t deny that they lost a child. Don’t encourage them to self blame or blaming others - nor push them to forgive others before they are ready. (There is usually a need to deal with hurts and anger first.) Don’t tell them they did the right thing or the best thing at the time. (For some they may believe this, but for others who think it, their hearts say otherwise and this causes turmoil and conflict.) Don’t suggest having another child someday to make up for the one that was lost. (Future children may be a blessing, but can never replace the one that died in the abortion or termination.) Don’t be afraid to encourage them to talk to specialty post abortion counsellors or go to a support group, (and to take a support person with them initially if that helps).
Do listen patiently as they try to sort out their feelings. Expect and allow them to bring up the subject again and again and listen for clues to their deeper feelings. Reassure them their feelings are normal for the experience that is abortion or termination. Allow them to get in touch with their hurt or anger, and help them see things more objectively. Do allow them to regret their decision, if that is what they are saying.
When people journey through their grief and can acknowledge their feelings and reality, they can get about the business of life again. For some there are spiritual longings and aspects that need to be addressed. Help them find appropriate sources of help.
- Carolina Gnad
Post Abortion Grief: Does it affect you?
Those who have come for counselling or joined the support group have found relief in talking about it, and knowing they are normal and not alone.
Reaching out for help can feel hard and you may be worried about what may happen if you share your experience.
Know that what you share is held in confidence.
Clips from The Abortion Providers’ Conference - Rotorua, March 2012
The theme of the conference was “Looking to the future,” Abortion Care in Australasia.
The scene was set by a number of presentations focusing on provision of ideal abortion services.
The emphasis was on needing to get rid of the stigma around abortion so it becomes available to all women who need it.
Dr Gill Geer (former Family Planning Association head in NZ and now Director General of International Planned Parenthood Federation) stated that there were 380,000 deaths last year internationally that were pregnancy related and 13% of were from unsafe/botched abortions, most in the undeveloped world, including Africa and Latin America. Gill termed it death by denial – denial of access to sexual and reproductive health and safe abortions and stated that it is a human right not to die in pregnancy. Gill talked of how public morality violates the human rights for women. It is a public health responsibility, and good abortion services are more cost effective than post-abortion care. She added that most women’s regret, is not in having an abortion, but in ever being in the position of needing an abortion, and most experience relief once it is over.
Dr Alison Knowles (who has a long time involvement in abortion services and established Medical Termination of Pregnancy at the Auckland Medical Aid Centre) spoke about Barriers to an Ideal Abortion Service in NZ. Alison talked about and rated aspects of abortion service provision in NZ. Availability was rated high as we have a publicly funded abortion service, safety was excellent with 1 to 3% readmission for Dilation & Evacuation and 2 to 6% Early Medical Abortion complications. Legal framework received a 7/10 rating. That abortion is free to New Zealanders was regarded as wonderful, however NZ abortion services fell well short in being client centred with the institutionalised and medicalised process. Waiting times at clinics (should offer a same day service), patients treated as a number, use of main operating theatres (unnecessary), lack of privacy, restricted contraception options, lack of choice of method at all clinics (should provide both surgical and medical at all facilities).
Christy Parker (Women’s Health Action) spoke about consumer’s perspectives on an ideal abortion service. In her abstract she stated: Given the enormous amount of public and political attention paid to abortion in comparison with other essential services, relatively very little is known about women’s experiences of abortion care in NZ and what women want from abortion services. Consumer feedback forms and satisfaction surveys offer some insight into women’s experiences of the care that could be improved. However evidence shows that patient feedback, particularly for procedures that carry some stigma, is often influenced by low expectations and/or consumer’ lack of knowledge and experience of diverse choices (Redshaw 2008, van Teijlingen et al, 2003)
Thanks, largely in part to the women’s health consumer movement in NZ, consumer representation and consultation is now accepted as vital for informing health service delivery and the rhetoric of patient-centred health care is alive and well in the public health system. However the ongoing stigma related to abortion, reinforced through its status in the law, constrains consumer voice in abortion care. In the absence of consumer voice, it is easy for doctors or providers to “think they know best”.
Christy highlighted how choice is important to keep a pregnancy or not, and how the stigma around abortion constrains enthusiasm for women to talk about their abortion experiences – they are silent consumers. Many of the feedback forms and satisfaction forms suffer from gratitude bias and the fear that negative feedback might undermine the service. For most there is relief that the procedure is over and consumer expectations are low. Often later conceptualisations are different around how the service may be better. Most find the surgical environment stressful. Abortion stigma is highly contextual and social constructs of embryos or foetus, or pregnant women as mother to be. Christy suggested the need for Consumer Reference Groups which can provide longer term feedback, with an email or phone line for later engagement. She also recommended that abortion education be part of the sexual health components in curriculums.
Trinh Lien (post-graduate student at the Department of Preventive and Social Medicine, University of Otago) presented her research on Abortion Amongst Asian Women in NZ. Trinh’s study consisted of two components: an epidemiological study of abortion trends and patterns amongst Asian women in NZ by analysing the abortion routine data during the period between 2002 and 2008 (both published and unpublished) provided by Statistics NZ; and a cross-sectional study of 188 self-identified Asian women who presented for abortion at four selected abortion clinics in NZ. NB Asia includes countries from Afghanistan in the west to Japan in the east, and China in north to Indonesia in south (not include Middle East, Central Asia or Russia.
Trinh found that
Main reasons for choosing abortion included: having a baby would dramatically change the woman’s life e.g. interfere with education or work or interfere with the responsibility of caring for other dependents, unable to afford to have a child, single motherhood or relationship problems, had completed childbearing or pressure from parents. About three quarters of the sample group specified their husband or partner helped them decide whether to get an abortion. Only about one third of participants thought a woman should be able to obtain an abortion if she wants it for any reason.
Dr Ruth Fitzgerald (Medical Anthropologist, University of Otago) is involved in the Marsden funded project “troubling choice”, involving studies of every day ethical reasoning by New Zealanders who have had personal experiences of needing to make choices about pregnancies following a diagnosis of fetal genetic difference. Ruth presented around the narrative positions of men as co-conceivers of the fetus, or as kin or friends to women undergoing terminations. The men’s abortion experiences were between 20 to 2 years ago. Their moral and political positions were diverse some very pro-life and some feminists, but with a majority holding unaffiliated political stance towards termination. Their ages ranged from between early twenties to mid seventies with varied social backgrounds including business men, educators, health professionals, skilled tradesmen, students and underemployed. Self revealed ethnic backgrounds included Pakeha, Maori, European and other Migrants and Asian/New Zealanders.
Grounded theory analysis of the moral reasoning approaches of the participants were used to focus on four future challenges for abortion counselling services which involve male clients.
1. A need for the identification of the models of masculinity currently constructed through expert clinical encounters for termination and a recognition of their ‘lack of fit’ with the gendered identities of some attending males.
2. The manner in which participants rationalise a woman’s “right to choose” and “their (the woman’s) body” to constrict their own options in decision-making around terminations. This holds implications for an abortion service constructed historically around a “woman’s right to choose” but which also serves male clients.
3. The lack of appropriate forum for men’s discussion and support during and after their experiences and the possibility and difficulty of providing such a forum.
4. The complexity of recruiting men into studies such as this. The lack of representatives of willing participants for the wider male population highlights the complexity of interpreting results in any study on this topic with ‘male’ participants.
Others speakers talked around conscientious objection, screening for family violence, changing methods of contraception, education and training for counsellors and abortion providers, methods for easing patients through the process of surgical termination of pregnancy. Social workers from Christchurch Women’s Hospital gave a moving talk around earthquake experiences and the changes and challenges of living and working there.
Carolina Gnad (trained nurse, counsellor, supervisor and spiritual director, founder and co-ordinator of P.A.T.H.S.) . Her topic was “Broadening Perspectives Around Termination of Pregnancy”.
Carolina mapped out the range of influences, individual, clinical, wider social... in the pregnancy and abortion areas. The question was raised is a woman making an abortion decision or a pregnancy choice? She spoke about the difference between the medical/clinical approach and what the patients’ understanding and their experiences may be.
Carolina spoke about the polarisation of pro-life and pro-abortion (traditionally regarded as “pro-choice”) factions and how the political moral debates have coloured and clouded the issues. She presented a continuum of views and beliefs and shared how P.A.T.H.S. and their counsellors have adopted a position that is “person-centred pro-life pro-choice”, and what that means: person-centred in offering unconditional positive regard and non-judgement, pro-life as in respecting the dignity and life of all involved in the abortion scenario (mothers, fathers, offspring, family, friends, medical staff, counsellors), and pro-choice, where people have the right to make decisions that affect them and their lives, but that for something to be a choice, three things need to be present, free will, full information, absence of pressure or coercion.
Participants were invited to self reflect around
Carolina showed how post abortion research is fraught with conflicts, limitations and methodological issues and how difficult it is for a practitioner to know which research can be relied upon. She went on to caution health practitioners in using research as a basis for their practice, that it does not replace proper assessment and effective professional responses. She mentioned the P.A.T.H.S. literary review around “The Impacts of Past Abortion on Subsequent Pregnancy, Birth and Postpartum Experience) and directed people to the P.A.T.H.S. website for the findings.
There were lots of questions raised around decision-making and counselling methods, informed consent, and follow up, and some recommendations for clinical practice.
There was definitely scope for more research around complications beyond the immediate post termination period, more research around longer term psycho-spiritual and relationship aspects, more studies needed around groups more at risk of negative reactions, and links to issues around subsequent pregnancy and parenting, e.g. postnatal depression and attachment difficulties. Another area of potential interest for research would be around the experiences of clinicians and other health practitioners working in the abortion services areas.
Overall it was an interesting conference, personally challenging on some fronts but some good learning and a good opportunity for networking.
- Carolina Gnad
My JourneyIt was at a prolife workshop in January 2011. I picked up each of the leaflets and booklets they had there, to see what they were like and what I could use. Among them was a small booklet from the P.A.T.H.S. organisation. And I started reading.... Could there be yet things in my life stemming from my abortion that I could untangle and thus become more able to be who I am supposed to be?
Half a year later I met one of the P.A.T.H.S. counsellors for the first time. I outlined my life so far.... and spoke about myself as a teenager. Last year of school, a sheltered, loving, cultivated, religious home with high standards. “Teacher’s pet”, always a good girl. My warm caring Mom. My cool, very self-disciplined, yet very caring Dad, with his own very hard childhood. Starting to mix with “The Drama Group”, young (and old) people from the local amateur theatre and the low moral standards there, especially in regards to relationships and sex.
Acquaintance with Kirt, falling in love. His background was a broken home, bitter mother and a father he hated. His communist / atheist world views clashed with mine. He criticises, is even angry at my parents for raising us the way they did.... My parents are increasingly concerned, warning me. Getting more involved physically, avoiding full intercourse as a means to avoid pregnancy.
In my last year of high school my monthly doesn’t occur as usual. I have no thought of pregnancy. Or do I? Very deep down? When feeling queasy is added to it, I wonder, petrified, horrified. Pregnancy test is negative! What a huge relief. Yet menstruation doesn’t return, morning sickness increases. Some weeks later, second pregnancy test: positive! The world spins, whirls, I am totally dizzy. The SHAME! Big flaming letters over me: THE S-H-A-M-E! For me, my family, and only now, thirty years later do I see it. SHAME especially for my father, who holds a high position in his company, highly respected whom many look up to. He is proud of his five daughters. And now, I his youngest, failed him, terribly! I cannot remember Kirt’s reaction. That is interesting, strange. What do we do? Yes, “we”, it is my parents and I, not Kirt and I, and not I alone.
Only now do I remember that Kirt had offered to stand by me “If you want to, we can raise this child together. We can make it!” Why had I pushed that memory aside? I remember shuddering at the thought of raising a child with him, passing on his world view. Anyhow, we could not possibly work together in child rearing! I would have to go it alone. This made it clearer, that I needed to separate from him - we had no future together.
The family at home wrestled and struggled in great secrecy over it. Time was running out. I was almost 12 weeks now. In my country abortion was only permitted for women with severe medical problems etc. We briefly touched on adoption. For some strange reason it appeared to me worse, more heartless than even abortion. Why?!?
My father was concerned that I would be tied to Kirt with this child. My mother offered to raise the child for me... at 60... what sacrifice, devotion, commitment. Dear, dear Mom!! Somehow I thought that being raised without a father was worse than not living at all. Even though my parents and I talked a lot, I knew, the final decision was mine.
Looking back now I believe the strongest deciding factor was SHAME - unable to face the world, wanting to hide how low I had fallen. And what about my father’s reputation... I couldn’t do this to him, I loved him very much.
We learned where there was a clinic that did illegal abortions for cash. My mother was going to a conference in that city so we tried to work the two things together. I went to a doctor and got a referral letter (the doctor I later learned received payment for each person she referred).
On 28 November 1979 I trudged up a dark staircase in an old, dark, back alley house. Darkness all around - on people’s faces, in the small waiting room, in our hearts. Then the general anaesthetic. My heart was screaming, wanting to rescue my baby, wanting to protect, to shield it against all harm. Waking up, fighting the reality of it all. The doctor who did IT, walked past, stopping and asked “Did you have intercourse?” I answered no. “Well, of course I had to break your hymen.” Walking on. How I hated him.
When I talked with the counsellor about THAT DAY, I came up against intense furious hatred toward this doctor... a new dimension of hatred I had not yet known.... I prayed for help to forgive again, hand him and them over to God. I feel the hatred melt away as fog disappears when the sun shines on it (strong enough). I trust it is defeated for good.... no coming back. Now as I write four months later I am still free from it. The day after this pivotal session I wrote to my counsellor:
Last night when we were together as a family singing “It took a miracle”, the last two lines of the chorus especially touched my heart, and I sense that the “Making me whole” is doing a big step forward through my journey with you. You ask good questions that shed light into foggy corners.
Last night as I reflected on the day and gazed once more at “that day”, words and phrases rose onto the scene:
- repulsion (very strong)
- grief (bottomless)
- the tragedy of the situation
- dark, dark everything
- mechanical, automatic movements, almost beyond my control
- cold people, dead people
- me betraying the child, its trust in me!!
- myself feeling betrayed (by whom?)
- wanting to jump up, rescue my child, let nobody harm it
- battling the reality of death, not wanting to accept it
- defeat, paralysed
- my broken, ruined body, violated, desecrated
Through this journey now, I will connect my present Me with my Me from then. I will become one continuous person. All Me. Whole....
It took a miracle to put the stars in place
It took a miracle to hang the world in space
But when He saved my soul, cleansed and made me whole
It took a miracle of love and grace!
What about naming my child? At first it seems too bold. I did not know its gender. Does it matter? Bridging the gulf is important, building a relationship now. During the weeks I sat with my counsellor I quietly listened for a name... Somehow I always believed she was / is a girl / woman. I never think of her as a child, but always as a young woman.
Yet as I dare name her, I notice one thing; Now I can look at her, fully, properly - and yet it feels like peeping through a small hole, secretly, so she won’t notice me. “She mustn’t see me”, I think. Why? I am so ashamed. I abandoned her. I failed her, betrayed her, broke her trust. I know Jesus forgave me, but can she forgive me? I cringe, I hide.... I am not worthy to be her mother..... But I conquer the fear to say out loud “I am the mother my children need.”
In later sessions we sift through Hurt, Anger and Forgiveness processes.
The idea of finishing the journey with a memorial service for the child (young woman in her thirties) appealed to me straight away, but while I was trying to visualise a way to do it, I understood, that all I really wanted, was to plant something in memory of her. A tree? A rose? No. I think a peony. Red - for the blood that was shed, hers, His... or white for her spotless life in Heaven, or both.
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