Abortion in Alabama

Abortion in Alabama is legal. Recent legislation, such as the "The Alabama Human Life Protection Act", has confused state constituents regarding the legality of abortion.[1] Alabama's political and overarching religious beliefs has presented Alabama residents with limited access to abortion services. As of 2021, only three clinics remain in Alabama all of which are located in metropolitan areas of the state.

"The Alabama Human Life Protection Act", signed by Alabama Governor Kay Ivey on May 15, 2019, would consider performing an abortion as a felony.[2] However, women who receive the abortion would not be held liable. This law would limit the conditions under which a woman could receive an abortion: a lethal anomaly or serious health risks to the mother. Other conditions in which a woman could receive an abortion is if she is not of age, ectopic pregnancy, or any medical emergency.[3] Alabama's restrictive abortion measures banned abortions from every angle. Doctors were to be criminalized if abortion procedures were to be performed at any stage of pregnancy.[4] Doctors performing these procedures are susceptible to prison time of up to 99 years or felony charges.[4]

The Alabama state legislature was active in trying to pass cardiogenesis or "fetal heartbeat" detection date abortion bans starting in 2014, and continuing unsuccessfully for the next few years. After the confirmation of Brett Kavanaugh to the US Supreme Court, the state legislature passed new legislation with the hope of challenging and overturning Roe v. Wade.  The number of abortion clinics in Alabama has been on the decline for years, going from 45 in 1982 to three in 2019.

Despite strong government and constituent support, abortion rights activism does take place in the state. One organization involved with this is the .  An examples of recent pro-choice activism in the state includes the #StoptheBans movement in 2019 held in Montgomery, Birmingham, Mobile, and Huntsville. Planned Parenthood is another organization involved in abortion rights activism. Planned Parenthood aimed to take legal action against the state of Alabama for depriving the option for women to have an abortion that was reaffirmed by the courts since Roe v. Wade.[4]

Terminology

The abortion debate most commonly relates to the "induced abortion" of an embryo or fetus at some point in a pregnancy, which is also how the term is used in a legal sense.[note 1] Some also use the term "elective abortion", which is used in relation to a claim to an unrestricted right of a woman to an abortion, whether or not she chooses to have one. The term elective abortion or voluntary abortion describes the interruption of pregnancy before viability at the request of the woman, but not for medical reasons.[5]

Anti-abortion advocates tend to use terms such as "unborn baby", "unborn child", or "pre-born child",[6][7] and see the medical terms "embryo", "zygote", and "fetus" as dehumanizing.[8][9] Both "pro-choice" and "pro-life" are examples of terms labeled as political framing: they are terms which purposely try to define their philosophies in the best possible light, while by definition attempting to describe their opposition in the worst possible light. "Pro-choice" implies that the alternative viewpoint is "anti-choice", while "pro-life" implies the alternative viewpoint is "pro-death" or "anti-life".[10] The Associated Press encourages journalists to use the terms "abortion rights" and "anti-abortion".[11]

Context

A 2011 study by Center for Reproductive Rights and found that states with more abortion restrictions have higher rates of maternal death, higher rates of uninsured pregnant women, higher rates of infant and child deaths, higher rates of teen drug and alcohol abuse, and lower rates of cancer screening.[12] The study singled out Oklahoma, Mississippi and Kansas as being the most restrictive states that year, followed by Arkansas and Indiana for second in terms of abortion restrictions, and Florida, Arizona and Alabama in third for most restrictive state abortion requirements.[12]

According to a 2017 report from the Center for Reproductive Rights and Ibis Reproductive Health, states that tried to pass additional constraints on a women's ability to access legal abortions had fewer policies supporting women's health, maternal health and children's health. These states also tended to resist expanding Medicaid, family leave, medical leave, and sex education in public schools.[13] In 2017, Georgia, Ohio, Missouri, Louisiana, Alabama and Mississippi have among the highest rates of infant mortality in the United States.[13] In 2017, Alabama had an infant mortality rate of 7.4 deaths per 1,000 births.[13] Medicaid expansion under the Affordable Care Act was rejected by Alabama, Georgia, Mississippi and Missouri. Consequently, poor women in the typical age range to become mothers had a gap in coverage for prenatal care. According to Georgetown University Center for Children and Families research professor Adam Searing, "The uninsured rate for women of childbearing age is nearly twice as high in states that have not expanded Medicaid. [...] That means a lot more women who don't have health coverage before they get pregnant or after they have their children. [...] If states would expand Medicaid coverage, they would improve the health of mothers and babies and save lives."[13] According to the 2018 Premature Birth Report Cards, Louisiana, Mississippi and Alabama were all given an F.[13]

According to the 2018 America's Health Rankings produced by United Health Foundation, Alabama ranked 7th in the country when it came to maternal mortality.[13] A 2018 March of Dimes report said the preterm birth rate among African American women in Alabama and Louisiana was much higher, 51% higher, than women of all other races in the state.[13]

Poor women in the United States had problems paying for menstrual pads and tampons in 2018 and 2019. Almost two-thirds of American women could not pay for them. These were not available through the federal Women, Infants, and Children Program (WIC).[14] Lack of menstrual supplies has an economic impact on poor women. A study in St. Louis found that 36% had to miss days of work because they lacked adequate menstrual hygiene supplies during their period.  This was on top of the fact that many had other menstrual issues including bleeding, cramps and other menstrual induced health issues.[14] This state was one of a majority that taxed essential hygiene products like tampons and menstrual pads as of November 2018.[15][16][17][18]

Alabama was one of only two states in the US (along with Minnesota) in 2019 that did not have a law that terminated parental rights of men who produced a child via rape or incest.[19][20] In 2019, an effort was made to pass legislation doing so in the case of rape, but it did not pass as such. It was changed to allow courts to terminate parental rights of parents who sexually abused their own children.[20]

History

Between 1892 and 1935, there were 40 prosecutions and five convictions in Alabama for women having abortions.[21]

Legislative history

Fetal heartbeat bills by state, including time limit without exceptions marked:
  Heartbeat bill passed (to go into effect)
  Law partially passed by state legislature
  Law blocked by court order

By the end of the 1800s, all states in the Union except Louisiana had therapeutic exceptions in their legislative bans on abortions.[21] In the 19th century, bans by state legislatures on abortion were about protecting the life of the mother given the number of deaths caused by abortions; state governments saw themselves as looking out for the lives of their citizens.[21]

By the end of 1972, Mississippi allowed abortion in cases of rape or incest only and Alabama and Massachusetts allowed abortions only in cases where the woman's physical health was endangered. In order to obtain abortions during this period, women would often travel from a state where abortion was illegal to states where it was legal.[22]

Dates of when heartbeat laws come into effect (as of May 25, 2019)

Judicial history

The US Supreme Court's decision in 1973's Roe v. Wade ruling meant the state could no longer regulate abortion in the first trimester.[21] In August 2018, the dilation & evacuation (D & E) legislation passed by Texas and Alabama were working their way through the federal courts appeal process.[23] The Eleventh Circuit ruled the D&E legislation to be unconstitutional, blocking it from being enforced, and the Supreme Court of the United States denied to hear its appeal in its 2019 term.

On February 6, 2019, filed a wrongful death lawsuit against an abortion clinic, , after his girlfriend had a legal abortion there in January 2017 as she did not want to continue her pregnancy. He also sued three employees of the clinic and the pharmaceutical company that made the drug for the medication induced abortion. Madison County Probate Judge Frank Barger recognized the status of the unborn fetus as a person on March 4, 2019 in accepting the case.[24]

In May 2019, Planned Parenthood and the American Civil Liberties Union said they would challenge Alabama's recently enacted abortion ban in the federal courts.[13] In June 2019, it was reported that a woman Marshae Jones; whose pregnancy was terminated after she was shot in the stomach in 2018 during a fight, was arrested on grounds of manslaughter of the fetus. The case is still on going.[25]

Clinic history

Total abortion clinics in Alabama by year.

Between 1982 and 1992, the number of abortion clinics in the state decreased by 25, going from 45 in 1982 to 20 in 1992.[26] In 2014, there were five abortion clinics in the state.[23] In 2014, 93% of the counties in the state did not have an abortion clinic.[27] That year, 59% of women in the state aged 15 – 44 lived in a county without an abortion clinic.[27] In 2017, there were two Planned Parenthood clinics in a state with a population of 1,117,288 women aged 15 – 49 of which two offered abortion services.[28]

was a clinic operating in the state in 2017.[24] There were five abortion clinics in Alabama in March 2019, and all were located in metro areas. They were located in Birmingham, Huntsville, Tuscaloosa, Mobile and Montgomery.[29] Of the five clinics operating in March 2019, one was only one on weekends.[29]

In 2019, the Yellowhammer Fund assisted women at three abortion clinics in Alabama in paying to have an abortion.[30] In May and June 2019, Alabama's abortion clinics were regularly getting calls from women trying to find out if they could still use their services to get a legal abortion; legislative changes had resulted in a lot of confusion from pregnant women about their abortion rights in the state.[31]

As of 2021, only three abortion clinics remain in Alabama: West Alabama Women's Center in Tuscaloosa, Reproductive Health Services in Montgomery, and Alabama Women's Center in Huntsville.[32] Currently, Alabama places restrictions on the location and advertisements of abortion clinics.[33] In order for abortion services in Alabama to remain in business, they must abide by abortion-care policies. A wide range of state and federal ordinances are to be followed by all Abortion services from healthiness to zoning requirements and now they must include the extra restrictions that Alabama has forced.[34] Abortion services are to be arranged as "ambulatory health care occupancy" that involves all of the substances needed in order to be compliant.[35] A law was enacted in 2016 that prohibited abortion clinics from renewing their current license if the clinic is within 2,ooo feet of an elementary or middle school.[34] In case of any abortion-related difficulties, facilities must have access to a hospital in the same statistical area as the abortion facility.[34]

Alabama and cardiogenesis

The state was one of 23 states in 2007 to have a detailed abortion-specific informed consent requirement.[36] By law, abortion providers in Alabama, Louisiana and Mississippi were required to perform ultrasounds before providing women with ultrasounds, even in situations like in the first trimester where an ultrasound has no medical necessity.[37] In 2013, state Targeted Regulation of Abortion Providers (TRAP) law applied to medication induced abortions and private doctor offices in addition to abortion clinics.[38]

The state legislature was one of five states nationwide that tried, and failed, to pass a fetal heartbeat bill in 2014.[39] House Bill 490 prohibiting abortions once a cardiogenesis or "fetal heartbeat" is detected passed the Lower House (73-29) on 4 March 2014.[40] The bill later died in committee.[41] Despite this, Alabama's Lower House was the first state in the nation to pass such a bill.[40] The state legislature tried and failed again in 2015 to pass similar legislation where they were one of three states, again in 206 when they were one of four states, and again in 2017 when they were one of eight states to attempt to pass a fetal heartbeat bill.[39]

The law as of March 2019 required women wait 24 hours after their initial appointment for an abortion before they could have a second appointment for the actual procedure.[29] State law at the time prohibited health insurance companies on public exchanges from offering abortion services unless the life of the woman was at risk, or the pregnancy was a result of rape or incest.[29]

Nationally, 2019 was one of the most active years for state legislatures in terms of trying to pass abortion rights restrictions. State governments with Republican majorities started to push these bills after Brett Kavanaugh was confirmed as a US Supreme Court judge, replacing the more liberal Anthony Kennedy. These state governments generally saw this as a positive sign that new moves to restrict abortion rights would less likely face resistance by the courts.[42]

The Alabama Human Life Protection Act

The most recent act relating to the abortion in Alabama is "The Alabama Human Life Protection Act" also known as the Human Life Protection Act. Formally, the act has the name of House Bill 314.The bill was drafted by the Alabama Pro-Life Coalition.[43] The bill responsible for banning abortions at every stage of pregnancy and criminalizing the procedure for doctors (except in the case of medical emergency) was introduced into the Lower House on April 2, 2019. The bill passed the Lower House on April 30th,[8] the Senate on May 14th,[9] and was signed into law by Governor Kay Ivey on May 16, 2019.[10]

Formerly, abortion cases involving incest or rape were allowed. With the introduction of the Human Life Protection Act, these cases were no longer an exception. Additionally, cases in which mothers faced a mental illness would be insufficient to provide an exception.[2] These restrictions identified the bill as one of the most aggressive anti-abortion laws in American history.[2] Although the bill was approved by Alabama legislators, Governor Kay Ivey recognized that its aggressiveness would most likely not be approved in the federal court due to the Roe v. Wade.[2] Despite this realization, Alabama legislators hoped the introduction of the bill could weaken pre-existing abortion protections.

Shortly after the introduction of the Human Life Protection Act, Planned Parenthood and ACLU of Alabama filed a lawsuit to challenge the bill on May 24, 2019. Serving as plaintiffs to the case were the three remaining abortion clinics in Alabama--Alabama Women’s Center, Reproductive Health Services, and the West Alabama Women’s Center.[44]

The controversal bill was set to go into effect on November 15, 2019. However, on October 29, 2019, the bill was blocked by the federal court.[43]US District Judge Myron Thompson granted a preliminary injunction on Tuesday October 28,2019 until the court is able to resolve the case in full. Federal judge, Myron H. Thompson, declared the bill defied previous rulings seen in Roe v. Wade and the U.S. Constitution. Furthermore, Judge Thompson expressed that the bill could have "serious and irreparable harm."[45]With this statement, Judge Thompson was referring to the Planned Parenthood Southeast v. Strange lawsuit from 2014 that identified a near-total ban as adding a financial burden to women and their need to access abortion services. As a result of this need, women are more likely to take unsafe measures to end pregnancies.[45]

Statistics

In the period between 1972 and 1974, the state had an illegal abortion mortality rate per million women aged 15 – 44 of between 0.1 and 0.9.[46] In 1990, 456,000 women in the state faced the risk of an unintended pregnancy.[26] In 2010, the state had nine publicly funded abortions, none of which were federally or state funded.[47]

59% of Alabama women lived in a county without an abortion clinic in 2014. There was an average of one abortion clinic every 10,483 square miles that year.[29]

Number of reported abortions, abortion rate and percentage change in rate by geographic region and state in 1992, 1995 and 1996[48]
Census division and state Number Rate % change 1992–1996
1992 1995 1996 1992 1995 1996
Total 1,528,930 1,363,690 1,365,730 25.9 22.9 22.9 –12
East South Central 54,060 44,010 46,100 14.9 12 12.5 –17
Alabama 17,450 14,580 15,150 18.2 15 15.6 –15
Kentucky 10,000 7,770 8,470 11.4 8.8 9.6 –16
Mississippi 7,550 3,420 4,490 12.4 5.5 7.2 –42
Tennessee 19,060 18,240 17,990 16.2 15.2 14.8 –8
Number, rate, and ratio of reported abortions, by reporting area of residence and occurrence and by percentage of abortions obtained by out-of-state residents, US CDC Estimates
Location Residence Occurrence % obtained by

out-of-state residents

Year Ref
No. Rate^ Ratio^^ No. Rate^ Ratio^^
Alabama -- -- -- 13,358 14 215 9.3 1992 [49]
Alabama -- -- -- 14,221 15 236 12.3 1995 [50]
Alabama -- -- -- 13,826 14 229 14,6 1996 [51]
Alabama 7,893 8.2 133 8,080 8.4 136 17.7 2014 [52]
Alabama 6,618 6.9 111 5,899 6.2 99 13.1 2015 [53]
Alabama 6,986 7.3 118 6,642 7.0 112 16.8 2016 [54]
^number of abortions per 1000 women aged 15–44; ^^number of abortions per 1000 live births

Abortion Incidents

Roughly 862,320 US abortions occurred in 2017. Of that Alabama, abortions account for only 0.7 percent. Although over 6,110 abortions occurred in Alabama in 2017 not all were given to Alabama residents. Some residents of other states have traveled to Alabama for abortions, as well as some Alabama residents have traveled to other states for abortions. Between 2014 and 2017 the Alabama abortion rate declined from 8 to 6 abortions per 100,000 women. This was a 23 percent decrease.

WHERE PATIENTS OBTAIN ABORTIONS

There are only 7 facilities that offer abortions in Alabama. This is a decrease from the 9 facilities that offered abortions in 2014. 93 percent of all the counties in Alabama do not provide any abortion services, and almost 60 percent of Alabama women live in these counties.

RESTRICTIONS ON ABORTION

Effective January 1, 2021, Alabama residents must receive state counseling when considering an abortion which includes information designed to discourage women from going through with the process. Patients then have to wait a 48 period before they can go through with the process. State health insurance plans will only cover abortions in case of rape, incest, or endangerment to the mother’s health. Alabama residents are no longer allowed to use telehealth services to receive abortion medication. Minors who seek abortion must receive consent from a parent or guardian or they will not be able to go through with the process. Public funding will be available for abortions in case of rape, incest, and endangerment.

Women's abortion experiences

had an abortion when she was a 17-year-old. While her father is a pastor at a Southern Baptist church and while he opposed abortion and read her Biblical verses to explain why abortion was wrong, King-Shepherd's father accompanied her to a clinic to get an abortion.  According to King-Shepherd, "I think that just speaks to the incredibly complex decision, not even just the decision to have an abortion, but the incredibly complicated beliefs surrounding abortion even."[31]

Abortion rights views and activities

Views

Abortion is a divisive issue in the state, with 37% of adults believing it should be legal in all or most cases and 58% believing it should be illegal in all or most cases.[55] In 2014, 37% of adults said in a poll by the Pew Research Center that abortion should be legal in all or most cases.[56] 58% of people in Alabama said abortion should be “illegal in all or most cases.”[57] According to a 2014 Public Religion Research Institute (PRRI) study, 60% of white women, the same percentage as white men, in the state believed that abortion should be illegal in all or most cases.[58]

Politically, the Alabama Executive Governor, Senate, and House report a majority of anti-choice views.[59] In recent years, white evangelical women have played a major role in helping Republican male anti-abortion rights candidates get elected. In 2017, around 63% of white women voted for Republican Roy Moore and not for Democratic senatorial candidate Democrat Doug Jones. 98% of black women voted for Jones.[58] One of the biggest groups of women who oppose legalized abortion in the United States are southern white evangelical Christians.  These women voted overwhelming for Donald Trump, with 80% of these voters supporting him at the ballot box in 2016. In November 2018, during US House exit polling, 75% of white evangelical Christian women indicated they supported Trump and only 20% said they voted for Democratic candidates. 75% of white evangelical Christian women voted for Moore in 2017.[58]

With states like Alabama and Georgia passing restrictive abortion laws in early 2019, some businesses announced they would boycott these states. Birmingham, Alabama Mayor Randall Woodfin said that these boycotts would likely mean two tech companies would not base themselves in the city.  Other states moved to try to take advantage of this political situation, including New Jersey where Governor Phil Murphy related a statement that said, “New Jersey is open for business for any company that, given the assault on a woman's right to choose perpetrated by states like Alabama and Georgia, is seeking a home that recognizes basic constitutional rights. [...] New Jersey offers not only a hospitable business climate, but also maintains its progressive values, which include defending a woman's right to choose. “[60]

President Amanda Reyes said in 2019, "Republicans don't have fewer abortions than Democrats or liberals or anarchists or communists. It's that our political rhetoric paints people who have abortions as largely the same — poor women, young women, irresponsible women, women who hate children. [...] It's gotten us to a point where we can't see the fact that we're all having abortions, and we're doing it for reasons we personally think matters — and that's all that matters. Pro-life women are having abortions, too."[30]

Organizations

The Yellowhammer Fund is an organization that financially assists women in Alabama who are seeking an abortion but have difficulty paying for one.[30]In May of 2020, The Yelllowhammer Fund purchased West Alabama's Women Center from retiring owner, Gloria Gray.[61] The organization purchased the clinic to ensure it would continue providing abortion services to the area. Yellowhammer Fund is currently striving to add additional services to the clinic including hormone therapy for transgender people, midwifery and doula care, and gynecological care.[61]

People Organizing for Women's Empowerment and Rights House (P.O.W.E.R. House) houses the Montgomery Area Reproductive Justice Coalition. It currently serves as Montgomery's only abortion clinic. Additionally, the clinic provides transportation and housing to those in need of these services. [62]

American Civil Liberties Union of Alabama (ACLU) is an organization striving to protect the right to abortion for all people.[63]ACLU's work centers around the courtroom to stop extreme attack's to women's reproductive rights.[64]Additionally, ACLU ensures governmental policies provide access to affordable contraception options.

Donations

After Alabama passed its abortion legislation in 2019, The National Network of Abortion Funds received more than US$262,000 in donations from more than 12,000 people.[65] Yellowhammer Fund also saw a huge surge. Because of fundraising efforts by one activist, the organization earned close to US$30,000 in donations in a three-hour period.[65]

Protests

On May 19, 2019, women from Montgomery participated in an abortion rights march, "March for Reproductive Freedom"[66] outside the Alabama Capitol building as part of a #StoptheBans rally, a protest against the newly abortion law signed by Governor Kay Ivey a week prior.[67][68] In conjunction to this protest, other Alabama protests took place in Birmingham, Huntsville, and Mobile on May 19, 2019.[30] The Birmingham rally was held in Kelly Ingram Park and had 2,000 supporters.[66] The rally in Huntsville had support from 1,000 people and was held in Butler Green Park.[66]Mobile hosted two rallies, one in Bienville Square and the other in downtown Mobile.[66]A smaller rally supporting the movement was held in Florence, Alabama. [66]

Political support

California Senator Kamala Harris held a 2020 Democratic Party Primary campaign rally in Birmingham on June 7, 2019. One of the messages she talked about during her rally was abortion rights in the state. During the rally, she said that if she were president, she would require the Department of Justice to review any state law restricting abortion “if it's coming from a state that has a history of limiting those rights.”  This way, the US Government would verify that such laws are constitutional before going into effect.[69]

Anti-abortion views and activities

Activities

is a non-profit family planning clinic in Fultondale that opposes abortions.  In 2019, they were seeking funding for a new ultrasound machine to assist pregnant women that use their services. Unable to pay for it on their own, the Southern Baptist organization donated the funds to support a clinic that teaches life begins at conception. The North Jefferson Women's Center will never refer women to an abortion provider, even if the pregnant woman desires such information.[31]

The Southern Baptist Convention held their annual convention in Birmingham in June 2019.  The timing was coincidental with the efforts in the state to restrict legal abortion access, but opposing legal abortions was part of their planned two-day discussion.[31]

An anti-abortion van parked outside of an abortion clinic

Violence

On May 12, 1984, two men entered a Birmingham, Alabama clinic on Mother's Day weekend shortly after a woman opened the doors at 7:25 A.M. Forcing their way into the clinic, one of the men threatened the woman not to prevent the attack while the other, wielding a sledgehammer, did between $7,500 and $8,500 of damage to suction equipment. The man who damaged the equipment was later identified as Edward Markley. Markley is a Benedictine priest who was the Birmingham diocesan Coordinator for Pro-Life Activities. Markley was convicted of first-degree criminal mischief and second-degree burglary. His accomplice was not identified.

The following month, June 15, 1984, Markley entered a women's health center in Huntsville, Alabama.[70] Kathryn Wood, one of the workers, received back injuries and a broken neck vertebrae while preventing Markley from splashing red paint on the clinic's equipment. Markley was convicted of first-degree criminal mischief, one count of third-degree assault, and one count of harassment in the Huntsville attack.[71]

Between 1993 and 2015, 11 people were killed at American abortion clinics.[72] The Army of God claimed responsibility for Eric Robert Rudolph's 1997 shrapnel bombing of abortion clinics in Atlanta and Birmingham.[73][72] The organization embraces its description as terrorist.[74] On January 29, 1998, Robert Sanderson, an off-duty police officer who worked as a security guard at an abortion clinic in Birmingham, Alabama, was killed when his workplace was bombed. Eric Rudolph admitted responsibility; he was also charged with three Atlanta bombings: the 1997 bombing of an abortion center, the 1996 Centennial Olympic Park bombing, and another of a lesbian nightclub. He was charged with the crimes and received two life sentences as a result.[75][76][72][77] Nurse Emily Lyons was permanently injured as a result of it.[72]

Footnotes

  1. ^ According to the Supreme Court's decision in Roe v. Wade:

    (a) For the stage prior to approximately the end of the first trimester, the abortion decision and its effectuation must be left to the medical judgement of the pregnant woman's attending physician. (b) For the stage subsequent to approximately the end of the first trimester, the State, in promoting its interest in the health of the mother, may, if it chooses, regulate the abortion procedure in ways that are reasonably related to maternal health. (c) For the stage subsequent to viability, the State in promoting its interest in the potentiality of human life may, if it chooses, regulate, and even proscribe, abortion except where it is necessary, in appropriate medical judgement, for the preservation of the life or health of the mother.

    Likewise, Black's Law Dictionary defines abortion as "knowing destruction" or "intentional expulsion or removal".


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