Natural Induced Miscarriage: The Simple, Safe Alternative. A Woman's Choice for Herbal Abortion

NATURAL INDUCED MISCARRIAGE

FOR DISADVANTAGED, PERSECUTED OR POOR WOMEN AROUND THE WORLD

Please fill in the following Questionnaire in order to receive the Article for free.s

Any information you can provide would be most helpful in assisting us with our work to provide choice for ALL women of the world. Please note that NO personal details will ever be released to any outside organisation.

What is your Email Address?

How old are you?

What ethnic group are you from?

If other... Please specify:

Which Country are you from?

If from US, Canada or Australia

Please tell us how you came to be pregnant. Check all that apply.

a) I had consensual sex with someone I cared for.

b) I had consensual sex with someone I did not care for. (ie I was bored, lonely, it was a rainy night or there was nothing on TV)

c) I was duped, drugged, or conned into having sex with someone who I would not normally have had sex with.

d) I was intoxicated (drunk, stoned, high) on alcohol or drugs due to my own actions. And I had sex without being fully aware of the situation.

e) I was 'date raped' by someone I know.

f) I was raped by a stranger.

g) I was raped by a family member.

h) I was gang raped by more than one person.

i) I used birth control but it did not work.

j) I did not use birth control.

What birth control method did you use? Check all that apply.

a) I did not use birth control.

b) We used a condom for men

c) Diaphragm, Cervical Cap or Shield

d) IUD (Intra Uterine Device)

e) Contraceptive Sponge

f) Rhythm Method

g) Birth Control Pill

h) Depo Provera

i) The Patch (Ortho Evra)

j) The Hormonal Vaginal Contraceptive Ring (NuvaRing)

k) Female Condom

l) Surgical Sterilization: Tubal Ligation or Vasectomy(or so he claimed!)

m) Spermicides

n) Withdrawal Method: to pull out "in time"!

o) Morning After Pill

p) I am Breastfeeding so I did not think I was fertile

q) Hope: I just did not think I would get pregnant.

If you used another birth control method, please describe:

Is Abortion legal or illegal in the country where you are from?

How difficult is it to get an abortion where you live

a) What penalties do you as a woman face from your FAMILY if you choose to have an abortion? (check all that apply)

school expulsion forced into prostitution husband leaves

beating from husband beating from father or other family member dis-owned by family

genital mutilation death by the hands of a family member

If there are other penalties, please describe them here:

b) What penalties do you as a woman face in your COUNTRY if you choose to have an abortion? (check all that apply) (check all that apply)

school expulsion deportation/banishment imprisonment

genital mutilation stoning execution for pregnancy out of wedlock

If there are other penalties - please describe them here:

If abortion service is available where you live, approximately how much does it cost in USD? $ USD

Use this space to send us any additional comments, suggestions or questions you may have.
Or, if you wish please tell us a little about yourself and how you came to this moment in your life:

HOW DID YOU FIND OUT ABOUT US?

If you found us with a web search, What Word or Phrase did you use?

Thank you kindly for taking the time to fill out this form.
We wish you the best in your decision.

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